PCP and Referral Requirements


Some Blue Cross and Blue Shield of Texas (BCBSTX) plans require the member to select a Primary Care Provider (PCP) who is responsible for referring the member for services to most specialty care providers and facilities. It is essential the PCP refer members, requiring such care, to participating physicians or professional providers within the member's same Blue EssentialsSM (including TRS ActiveCare Primary and TRS ActiveCare Primary+ who use the Blue Essentials network), Blue Advantage HMOSM, Blue PremierSM or MyBlue HealthSM provider network.

When the member’s plan requires a referral, the PCP must submit the referral request to BCBSTX via the following methods:

  • The easiest and most convenient option 24/7 for submitting or to review referral requests is using Availity® Authorizations & Referrals. Refer to the link for information on accessing and tip sheets. This service is free of charge.
  • Call 1-800-451-0287 and utilize the interactive voice response (IVR) system. Refer to the Referral Request Caller Guide.
  • Call the authorization phone number on the back of the member’s ID card.

Once the referral is approved, you will be issued a confirmation number to share with the member and the specialty provider/facility. The specialty provider/facility can also access it by logging on to Availity Authorizations and Referrals.

For more information on plans that require PCP and Referrals, refer to HMO Plans - PCP Selection and Referral Requirements or our Blue Essentials, Blue Advantage HMO, Blue Premier and MyBlue Health Provider Manual.


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 provided by third party vendors.