01-26-2024
Participants enrolled in the HealthSelect of Texas In-Area medical plan are required to have a designated PCP on file with BCBSTX to receive in-network benefits. Prior authorization is also needed for some services.
For in-network benefits to apply, specialty providers must have a valid referral on file with BCBSTX prior to submitting a prior authorization. If a referral and a prior authorization are required, and the participant does not have a valid referral on file from their PCP with BCBSTX before rendering the authorized services, claims you submit may be processed at the lower out-of-network benefit level.
For more information refer to the ERS Tools page.