Feb. 17, 2020
There are important changes to the prior authorization requirements for the HealthSelect of Texas® and Consumer Directed HealthSelectSM plans administered by Blue Cross and Blue Shield of Texas (BCBSTX). The list of services requiring prior authorization has not changed; however, beginning March 1, 2020, prior authorizations for services previously managed by eviCore healthcare® will now be managed through BCBSTX.
What’s changing?
You must contact BCBSTX to prior authorize the following services as of March 1, 2020:
- High-Tech Radiology (CT, PET Scans, MRI, MRA and Nuclear Medicine)
- Molecular and genomic testing
- Radiation oncology for all outpatient and office services
- Sleep studies and sleep durable medical equipment
Please reference the most up-to-date HealthSelect of Texas Prior Authorization & Referral Requirements Lists located under Clinical Resources on the provider website.
It is critical that providers use Availity® or your preferred vendor to check eligibility and benefits, determine if you are in-network for your patient, and decide whether any prior authorization is required. Availity allows you to confirm if prior authorization is required based on the procedure code. For more information on Availity, refer to “Eligibility and Benefits” located on the provider website.
To prior authorize services through BCBSTX, submit online using Availity Authorizations & Referrals or call the phone number listed on the member’s BCBSTX ID card. Providers who are not yet registered with Availity can sign up by visiting the Availity website. There is no charge for this service. If you need assistance, call Availity Client Services at 1-800-282-4548.
If you have any questions, contact your Network Management office.
As a reminder, it is important to check eligibility and benefits before rendering services. This step will help you determine if benefit prior authorization is required for a member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX’s provider website.
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.
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 Availity, Aerial 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.