Prior Authorization Exemption Issue: Incorrect Notification Letter RESOLVED

As of Oct. 7, 2022, this issue has been resolved.


On Oct. 1, 2022, Blue Cross and Blue Shield of Texas (BCBSTX) implemented Texas House Bill 3459 for Prior Authorization (PA) Exemption(s) which allows providers that meet the necessary criteria, PA exemptions for particular service(s).

We are experiencing an issue when providers submit a Notification through Availity® to inform BCBSTX of initiating a service or procedure for which they have a PA Exemption. The provider receives a response that the Notification was accepted and a letter is generated, showing an incorrect date span, no procedure code(s) or the number of units. A second letter may automatically be generated that does include the correct procedure code(s), number of units and date span. We know this may lead to some confusion and we are working to resolve the issue.

As a reminder, providers can always check Availity for the accurate procedure code(s), number of units, and date span.

Don’t have an Availity Essentials account?
Register today by going to Availity or contact Availity Client Services at 1-800-282-4548.

More Information
Check our Prior Authorization Exemption page for more information on Prior Authorization Exemption(s). Watch future News and Updates for additional information on this issue.

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. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.