In 2027, Health Care Service Corp. will stop issuing courtesy prior authorizations in its three Medicaid states — Illinois, Texas and New Mexico — for services that do not require authorization.
According to the insurers’ notices, courtesy prior authorizations are requests that providers submit for services that do not need prior authorization under benefit plans, regulatory requirements, contractual provisions or clinical policies.
“Eliminating these unnecessary requests helps reduce administrative burden, streamline processes and improve consistency in communicating authorization requirements,” the notices said.
The HCSC plans said providers should reference authorization resources, provider portal tools and provider support channels to verify whether prior authorization is necessary for services. Providers should carry out the covered services as appropriate and submit claims through established billing procedures.
The change goes into effect Jan. 1 for Blue Cross and Blue Shield of Texas Medicaid, whereas the effective date is Feb. 1 for the other Blues plans. The update does not modify existing prior authorization requirements.
