April 2, 2020
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 Blue Cross and Blue Shield of Texas (BCBSTX) should be submitted using the Availity Authorizations and Referrals tool. This includes prior authorization requests for inpatient admissions, select outpatient services and referrals handled by BCBSTX.
For the Federal Employee Program® (FEP®), providers should continue to use their current prior authorization process until this new tool becomes available soon for FEP members.
Behavioral Health Update
Behavioral health services that require prior authorization handled by BCBSTX may now be submitted online via the Availity Authorizations and Referrals tool.
For More Information
Refer to the Availity Authorization & Referrals page as well as our educational Availity Authorizations User Guide and Availity Referrals User Guide located under the Provider Tools section of our provider website. If you need further assistance or customized training, contact our Provider Education Consultants.
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.
- Check the patient's eligibility and benefits first to determine if prior authorization is required for the service and/or procedure code. For online assistance, refer to the General Eligibility and Benefits Expanded Tip Sheet.
- 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 by using the Predetermination Request Form along with the pertinent medical documentation.
Please note that the fact that a service has been prior authorized/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.