Effective June 25, 2007, preauthorization for the following services will no longer be required for HMO members as long as the service is provided by a participating Network Physician/Professional Provider and/or a Facility/Ancillary Provider:

• Durable Medical Equipment (DME)
• Home Infusion Therapy (HIT)
• Outpatient procedures (formerly listed in the HMO Blue Texas Outpatient Procedure Preauthorization List)

Out-of-Network/Out-of-Plan services always require medical management review. If preauthorization or referral is not obtained for an HMO member requiring Out-of-Network/Out-of-Plan services, no benefits are available and claims will be denied. Emergency services are an exception to this requirement.

Please refer to the HMO Blue Texas Preauthorization/Notification/ Referral Requirements for an updated list of the preauthorization requirements.

Note: Physicians/Professional Providers who are contracted/affiliated with a capitated IPA/Medical Group, and physicians/professional providers who are not part of a capitated IPA/Medical Group but who provide services to an HMO member whose PCP is a member of a capitated IPA/Medical Group, must contact the applicable IPA/Medical Group for instructions regarding referral and preauthorization requirements.

For a complete list of services requiring preauthorization:

Beginning June 25, 2007 - HMO Blue Texas Preauthorization/Notification/Referral Requirements

Until June 25, 2007 - HMO Blue Texas Preauthorization/Notification/Referral Requirements