BlueCard® Preauthorization Requirements for Blue Choice Providers

As a PPO/POS or Traditional contracted provider with Blue Cross and Blue Shield of Texas, you are responsible for the completion of the preauthorization process.

  1. Request preauthorization requirements when requesting benefits and eligibility. As a reminder, preauthorization requirements may vary based on the member's benefits.
  2. Notify the appropriate Plan prior to rendering services for services requiring preauthorization, or as soon as possible for emergent care:
    • For members enrolled in an out-of-state PPO or Traditional policy, you should contact the Plan in which the member is enrolled (i.e., Blue Cross and Blue Shield of Florida or Blue Cross and Blue Shield of California).
    • For members enrolled in a POS policy (Primary Care Physician assigned), you should contact the Plan in which the PCP is enrolled.
    • To assist in contacting the appropriate Plan, the preauthorization phone number is provided on the back of each member’s identification card.

  3. Contact the Plan that issued the preauthorization with updated or clinical information as necessary if there is a change in the patient status from the original preauthorization.

The preauthorization must cover the entire date span and all services submitted on the claim in order to avoid requests for additional information and possible delays or denials.

Note: Failure to preauthorize may result in reduced payment, and Physicians or other Professional Providers cannot collect these fees from subscribers. Out-of-network services require preauthorization.