May 1, 2019
There is an important change to the prior authorization requirements for your Blue Cross and Blue Shield of Texas (BCBSTX) patients who are American Airlines members and have the Blue Choice PPOSM health plan.
Effective Aug. 1, 2019, for the spinal fusion surgery codes listed below, instead of requesting prior authorization through BCBSTX, you will need to obtain prior authorization through eviCore healthcare (eviCore) an independent specialty medical benefits management company.
The list of the spinal fusion surgery procedures* that will require prior authorization through eviCore as of Aug. 1, 2019, are listed below:
Spinal Fusion Surgery Procedure Codes
*Note: This list is not exhaustive of all codes that require prior authorization for American Airlines members. It is imperative to use Availity® or your preferred vendor to check eligibility and benefits, determine if you are in-network for your patient and whether prior authorization or prenotification is required. Availity allows you to determine if prior authorization is required based on the procedure code. Refer to "Eligibility and Benefits" on the provider website for more information on Availity.
American Airlines members can be identified by employer group # 120369, 150554, 169026, 169027, 169028, 169029 or 186287 on their BCBSTX identification cards. Payment may be denied if you perform procedures without authorization. If this happens, you may not bill your patients.
Once you have determined your service requires prior authorization through eviCore, use one of the following methods to obtain authorizations:
- Go online to the eviCore web portal. After a one-time registration, you can initiate a case, check status, review guidelines, view authorizations and eligibility and more. This is the quickest, most efficient way to obtain information.
- Call eviCore at 855-252-1117 toll-free between 6 a.m. to 6 p.m. CT, Monday through Friday and 9 a.m. to noon CT, Saturday, Sunday and legal holidays.
For other services requiring prior authorization through BCBSTX, continue to use iExchange® to preauthorize those services. For more information or to set up an iExchange account, visit iExchange on the provider website.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.
eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSTX.
Aerial, iExchange and Medecision® are trademarks of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.
Please note that verification of eligibility and benefits information, and/or the fact that any pre-service review has been conducted, 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.