Recently Blue Cross and Blue Shield of Texas updated our Medical Policy page and link. Be sure to change your bookmark to the updated link. After reviewing and agreeing to the disclaimer, the new page provides navigation on the left-hand panel to:
- Government Program Policies
- Active Policies
- Pending Policies
- Draft Policies
When Policies are Posted
New or revised medical policies, when approved, may be posted on the BCBSTX provider website on the 1st or 15th day of each month. Those medical policies requiring disclosure will become effective 90 days from the posting date. Medical policies that do not require disclosure will become effective 15 days after the posting date. The specific effective date will be noted for each medical policy that is posted. To streamline the medical policy review process, you can view draft medical policies and provide your feedback online. If there are any draft medical policies to review, these documents will be made available for your review around the 1st and the 15th of each month with a review period of approximately two weeks.
Refer to the Recommended Clinical Review Option page for information on submitting a request for review of your services prior to rendering the service. In addition, other policies and information regarding payment can be found on the Clinical Payment and Coding Policies page.
The BCBSTX Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. Providers are instructed to exercise their own clinical judgment based on each individual patient’s health care needs. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Some benefit plans administered by BCBSTX, such as some self-funded employer plans or governmental plans, may not utilize BCBSTX Medical Policies. Members should contact the customer service number on their member ID card for more specific coverage information.