April 5, 2019
Beginning July 15, 2019, we will be improving our claims review process for behavioral health services that require prior authorization. This will result in more consistent and accurate claims payment.
As a reminder, the following behavioral health services may require prior authorization:
- Services provided in the following settings:
- Inpatient acute facilities
- Residential treatment facilities
- Partial hospitalization
- Intensive outpatient therapy
- Focused outpatient management
- Psychological or neuropsychological testing
- Applied behavior analysis
- Repetitive Transcranial Magnetic Stimulation (rTMS)
Services performed without prior authorization, if required, will be denied for payment and providers may not seek reimbursement from Blue Cross and Blue Shield of Texas (BCBSTX) members.
- Visit the BCBSTX provider website for more information regarding:
- Behavioral health prior authorization requirements
- Behavioral health request forms
You should always check eligibility and benefits for each member before treatment. This step will help you confirm applicable prior authorization requirements. You may check eligibility and benefits online for BCBSTX, out-of-area Blue Plan and Federal Employee Program® (FEP®) members via the Availity® Provider Portal or your preferred vendor portal.
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 Blue Cross and Blue Shield of Texas (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.
Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have questions, contact the number on the member’s ID card.