Clinical Guideline Criteria

Blue Cross and Blue Shield of Texas uses Medicare and internal medical policies to make sure that you can get the best health care.

Doctors use evidence-based clinical guidelines to make sure you get the health care you need. All criteria used is based on scientific and medical research.

Our clinical team applies clinical guidelines to make sure you are getting safe and necessary care. There are no rewards to deny or promote care.

Always talk to your doctor about any health questions or concerns. You can also check with your doctor if you have questions about prior authorization or medical policies.

Use the links below to review BCBSTX and vendor guidelines that may apply.

• BCBSTX Medical Policies
• eviCore
  • From the Clinical Guidelines page linked above; choose the category that best fits your needs.
  • Choose to accept the pop up to allow access to the information
  • In the search bar type the name of your plan:
    • Use the format below to easily find your information based on your plan:
      • BCBS TX - Medicaid/Medicare
  • If there is information for your plan in this category, you will find it here.
• American Society of Addiction Medicine (ASAM)*
• MCG Care Guidelines Website Instructions

If you want to know more about the utilization management process or how decisions are made about your care, Contact Us.

*Licensee's use and interpretation of the American Society of Addiction Medicine's ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.