Blue Cross and Blue Shield of Texas has contracted with EviCore healthcare to provide utilization management prior authorization services for proton beam therapy for Medicare Advantage members. For other services for our members, prior authorization may be required through BCBSTX.
Check Member Eligibility and Benefits
Use Availity® Essentials or your preferred vendor to check eligibility and benefits before rendering services. This step will help you determine if prior your services require prior authorization through BCBSTX or EviCore.
Prior Authorization Code Lists
You can also refer to Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM to determine which services require prior authorization (for medical necessity).
EviCore Resources and Contact Information
For more detailed information, visit the Provider Resources page on the EviCore Providers' Hub and select the BCBSTX health plan for the applicable procedure code lists and physician worksheets by service.
Submit your prior authorization request for proton beam therapy to EviCore:
- Online – The EviCore Web Portal is available 24x7.
- By phone – Call EviCore toll-free at 855-252-1117 from 7 a.m. to 7 p.m. CT Monday through Friday and 9 a.m. to noon Saturday, Sunday and legal holidays.
Watch News and Updates and Blue Review for additional information on EviCore.
Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Prior authorization of a service is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any Prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.
EviCore healthcare is an independent company that provides utilization review for select health care services on behalf of BCBSTX.
Availity is a trademark of Availity, LLC, 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 third party vendors and the products and services they offer.