11/29/2022
Below is an additional update to the Blue Cross and Blue Shield of Texas (BCBSTX) prior authorization requirements for Medicare Advantage members to reflect removed codes due to updates from Utilization Management or the American Medical Association (AMA) effective Jan. 1. 2023.
Updated Changes
The prior authorization list, currently posted for Jan. 1, 2023, includes the below additional change not included in the previous article posted Oct. 20, 2022:
- Removal of Lab codes previously reviewed by eviCore
Refer to Prior Authorization Lists on the Utilization Management section of our provider website. The revised lists can be found on the Prior Authorization Lists for Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM page.
Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity® or your preferred vendor.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
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eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSTX.
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