What’s Changing: In addition, to new codes added as indicated in previous notice, Blue Cross and Blue Shield of Texas (BCBSTX) removed prior authorization requirements for some codes and replaced a specialty drug code for Medicaid members to reflect updates from Utilization Management or the American Medical Association (AMA) effective July , 2023. The impacted codes were previously reviewed by eviCore healthcare.
Medicaid: The Prior Authorization Lists and Reports previously posted for 07/01/2023 on the Utilization Management section of our Medicaid provider website page reflect these changes.
Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity® or your preferred vendor.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
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Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX.
eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.