ERS Tools

Blue Cross and Blue Shield of Texas is the third-party administrator for the Employees Retirement System of Texas HealthSelect of Texas® and Consumer Directed HealthSelectSM benefit plans that access care through a custom point-of-service network using the Blue EssentialsSM network in all 254 counties in Texas.

Medical necessity does not guarantee payment. Eligibility and other plan requirements must be met. You can access HealthSelect and Consumer Directed HealthSelect documents here.

ERS Participant Plans

HealthSelect of Texas

  • Participants must select a primary care provider participating in the Blue Essentials provider network.
  • Referrals are required to see Blue Essential providers for in-network benefits.

    • Important: Participants are required to obtain a referral from their PCP prior to seeing a specialist for most services even if the specialist received medical necessity approval by completing a voluntary or recommended clinical review.

  • Referrals are not required for the following:

    • Covered vision care, including routine and diagnostic eye exams
    • OB/GYN visits
    • Mental health counseling
    • Chiropractic visits
    • Occupational therapy and physical therapy
    • Virtual visits through MDLIVE® and Doctor On Demand®, urgent care centers and convenience care clinics
    • Dermatology visits, effective Jan. 1, 2025

Consumer Directed HealthSelect

  • Participants have access to the Blue Essentials provider network.
  • PCP selection and referrals are not required on this plan.

HealthSelect of Texas and Consumer Directed HealthSelect Out-of-State

  • ERS participants living outside of Texas have access to the Blue Cross and Blue Shield national PPO network as part of the BlueCard® Program.
  • PCP selection and referrals are not required for out-of-state plan participants.

HealthSelect Secondary 65+

  • ERS Retirees and Participants are eligible for Medicare.
  • ERS participants with primary or secondary Medicare coverage have access to our Traditional/ParPlan network.
  • PCP selection and referrals are not required on this plan.

Prior Authorization

Prior authorization is no longer required for any services. Medical necessity reviews will be conducted after services are rendered unless a recommended clinical review is requested.  

Recommended Clinical Review

Providers may request a recommended clinical review for a preservice medical necessity determination. RCR will inform you of situations where a service may not be covered based upon medical necessity or other plan rules and typically prevents the need for post-service medical necessity reviews for the requested procedure codes or services.

Refer to recommended clinical review for more information and a list of applicable services. The list will indicate whom to contact for the review request. Providers may continue to request medical necessity review of additional services even when not included on the recommended clinical review services list.

Review Carelon policies: BCBSTX moved certain categories of care to Carelon for ERS on Sept. 1, 2024. To ensure services are covered, you should review Carelon policies. Recommended clinical review (a voluntary pre-service review) may be available.    

Outpatient lab and imaging

Providers submitting RCR requests for services managed by BCBSTX for ERS participants have the option of submitting the request electronically via the Availity® Authorization & Referrals tool or via BlueApprovRSM.

Review Carelon policies: Carelon is delegated for lab and imaging reviews for ERS. Review Carelon policies to ensure services are covered. Recommended clinical review (a voluntary pre-service review) may be available.    

Important Note: Plan providers must refer members to in-network imaging centers, lab providers and other facilities for outpatient lab and imaging services whenever possible. Visit our Provider Finder® to locate in-network providers and facilities. 

How to become an in-network provider for ERS participants

To provide in-network services for ERS participants, the following is required: 

  • Privileges at one of the Blue Essentials/HealthSelect participating hospitals (unless inpatient admissions are uncommon or not required for your specialty or you have someone who will admit on your behalf)
  • A valid National Provider Identifier number
  • A signed Blue Essentials agreement

Please visit our network participation page for more information.

Mental Health Services

BCBSTX manages mental health benefits and services for HealthSelect plans, including network management.

Telemedicine and Virtual Visits

HealthSelect participants have benefits for telemedicine/telehealth and virtual visits.

Virtual Visits
Medical and mental health virtual visits are available through Doctor On Demand and MDLIVE®. Use the Availity® Essentials or your preferred vendor to check eligibility and benefits.

Telemedicine/Telehealth
Use the Availity Essentials  or your preferred vendor to check eligibility and benefits. You can also refer to Section 5, Schedule of Benefits and Coverage, in the plan’s Master Plan Benefits Documents for more information.

Submitting Telemedicine/Telehealth and Virtual Visit Claims
For details on submitting telemedicine/telehealth claims, refer to our Telemedicine and Telehealth Services page.

Outpatient Clinical Laboratory Information

All Plan providers should refer members to in-network lab providers for outpatient lab services. To locate participating labs in the Plan network, visit Provider Finder®.

Statewide In-Network Clinical Labs for HealthSelect Participants include:.

  • Clinical Pathology Laboratory (CPL) — For locations or questions, contact CPL at 800-595-1275 or visit CPL's website.
  • LabCorp — For locations or questions contact LabCorp at 888-LAB-CORP or visit LabCorp's website.
  • Quest Diagnostics, Inc — For locations or questions contact Quest at 888-277-8772 or visit Quest's website.

    Important Note:     Providers should verify the specific lab location is participating at the time of service.

Reminder: Effective Jan. 1, 2025, all lab services are subject to the Laboratory Management Policies listed on the Clinical Payment and Coding Policies page.

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