02/28/2024
As notified on Nov. 30, 2023, effective March 1, 2024, certain inpatient services for Teacher Retirement System of Texas (TRS) participants are moving from prior authorization to the Recommended Clinical Review Option (RCR)
The following services will no longer require prior authorization and RCR will be available:
Elective Inpatient Medical/Surgical Facility Admissions Including Transfers:
- Acute Care / Hospital Hospice, Maternity, Medical, Surgical, Transplant
- Hospice Care
- Long Term Acute Care / Sub-acute
- Rehabilitation Facility
- Skilled Nursing Facility
Elective Behavioral Health and Chemical Dependency Facility Admissions:
- Inpatient
- Residential Treatment Center (RTC)
Refer to the RCR page for information on RCR services and how to submit requests. Claims for services for which the RCR option is available will be subject to retrospective review if a provider elects not to submit a request for RCR.
Submitting a recommended clinical review evaluates the medical necessity of a service but does not guarantee the service will be covered under the participant’s benefit plans. The terms of the participant’s plan control the available benefits.
For More Information
Learn more about our utilization management process, including prior authorization and recommended clinical review in the Utilization Management section of our provider website.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.