Administration of Behavioral Health Programs
Blue Cross and Blue Shield of Texas (BCBSTX) administers behavioral health services (mental health and substance use disorder) for members who have behavioral health benefits through a variety of retail, government and group products.
The following plans are administered by BCBSTX Behavioral Health Care Management:
- Blue Choice PPOSM
- Blue Cross Medicare Advantage PPOSM
- Blue EssentialsSM
- Blue High Performance Network® (BlueHPN®)
- Blue PremierSM and Blue Premier AccessSM.
- Employees Retirement System of Texas (ERS)
- Federal Employee Program (FEPSM)
- Teacher Retirement System of Texas (TRS)
The following plans are administered by Magellan Healthcare® (Magellan) for behavioral health services:
- Blue Advantage HMOSM, Blue Advantage PlusSM HMO
- MyBlue HealthSM
- Blue Cross Medicare Advantage HMOSM
- Medicaid STAR, CHIP and STAR Kids.(Note: Care Management is managed by BCBSTX as of 06/27/22. Refer to Medicaid Behavioral Health for more information)
In addition, some groups may select other vendors to administer their behavioral health services. For that reason, it is imperative to use Availity® or your preferred vendor to obtain eligibility and benefits, determine who is responsible for administering behavioral health benefits and prior authorization requirements.
Behavioral Health Program Overview
BCBSTX’s behavioral health care management is integrated with our medical care management program, to help members access their behavioral health benefits and to improve coordination of care between medical and behavioral health providers. This program will help our clinical staff identify members who could benefit from co-management earlier and may result in:
- Improved outcomes
- Enhanced continuity of care
- Greater clinical efficiencies
- Reduced costs over time
Some members* may be referred to other medical care management programs that are designed to help identify and help close potential gaps in care through evidence-based and member-focused approaches to health care and benefit decisions.
All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan.
Behavioral Health Program Components
Our program includes a portfolio of resources to help our members access benefits for behavioral health (mental health and substance abuse) conditions as part of an overall care management program. Learn more
Behavioral Health Utilization Management Program Overview
Our Behavioral Health team follows members as they step down from intensive inpatient, residential or partial hospitalization to less intensive levels of care (outpatient). Learn more
Behavioral Health Medical Necessity Criteria & Prior Authorizations
The BCBSTX Behavioral Health team uses nationally recognized, evidence-based and/or state or federally mandated clinical review criteria and issue prior authorizations for all behavioral health clinical decisions. Learn more
Behavioral Health Quality Indicators
Behavioral Health providers have contractually agreed to offer appointments to our members according to specific appointment access standards. Learn more
Behavioral Health Contacts & Additional Information
Questions? We’re here to help. Learn more
Our Behavioral Health Care Management program is accredited for Health Utilization Management. This accreditation covers the Behavioral Health Utilization Management program for Commercial/Group, FEP and Retail Exchange Affected Markets lines of business.
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC strives to ensure that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org.
* Members experiencing inpatient hospitalization, complex or special health care needs or who are at risk for medical complications may be referred to medical care management programs through a variety of mechanisms such as predictive modeling, claim utilization, inbound calls, self-referrals and physician referrals. If members do not have medical care management programs as part of their group health plans, they will not be referred to other medical care management programs.
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. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by independent third-party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.