Oct. 29, 2021
To identify if a service requires prior authorization for our members, always check eligibility and benefits through Availity® or our preferred vendor for services requiring prior authorization including those below:
- As a provider rendering Coordinated Home Care (CHC) and Home Infusion Therapy (HIT), you can submit initial prior authorizations for both CHC and HIT requests via Availity . Always submit the correct service type to avoid delays.
- Referrals or prior authorizations for therapy services should be submitted separately.
- You will get a real-time Availity or clinical review response per the prior authorization guidelines for initial requests by fax or phone directly to the provider.
What should you do?
- Provide all pertinent information related to your patient services.
- Specifically submit:
- Referrals should only include consultation CPT codes. Note: referrals are for HMO plans only.
- Prior authorizations with correct codes for CHC, HIT or therapy services
- Call 1-800-441-9188 for concurrent/extensions requesting additional units or days. ever submit concurrent/extensions via Availity to avoid delays. You will receive your responses for additional units or days for current/extensions from Blue Cross and Blue Shield of Texas via fax or a phone call directly to the provider per concurrent/extension guidelines.
If you have questions, please call the number on back of the member's ID card or 1-800-441-9188.