Feb. 27, 2020
This is a follow-up to a previous notice regarding delayed implementation of the new Availity Authorizations & Referrals tool, which was originally scheduled to launch in late January 2020.
We're pleased to announce that the Availity Authorizations & Referrals tool (HIPAA-standard 278 transaction) is available as of Feb. 17, 2020 for submission of prior authorization and referral requests handled by Blue Cross and Blue Shield of Texas (BCBSTX). This includes prior authorization requests for inpatient admissions, select outpatient services and referrals.
For Federal Employee Program® (FEP®) members and behavioral health services, you should continue using your current prior authorization process until this new tool becomes available in the near future.
Important Reminders:
- If you haven't registered with Availity, you can sign up for free on the Availity website. For help, contact Availity Client Services at 1-800-282-4548.
- The process of submitting prior authorization requests through eviCore healthcare (eviCore) or other vendors is not changing.
- Medical and surgical predetermination of benefits requests should be submitted via fax or mail using the Predetermination Request Form, along with the pertinent medical documentation.
- Our current electronic prior authorization submission tool, iExchange®, will be deactivated on April 15, 2020. As of this date, all electronic prior authorization and referral requests handled by BCBSTX should be submitted using the Availity Authorizations & Referrals tool.
Training and Support
We are hosting additional Availity Authorizations & Referrals training webinars for you to learn how to use this new tool. Select the link below for your preferred date and time to register.
March 2, 2020 — 3 to 4 p.m
Also refer to the Provider Tools section of our website to view the new Availity Authorizations User Guide and Availity Referrals User Guide.
If you have questions or need customized training: Contact our Provider Education Consultants.
Please note that the fact that a service has been preauthorized/pre-notified 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 any questions, call the number on the member's ID card.
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. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. eviCore is wholly responsible for its own products and services. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, eviCore or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.