New BlueApprovRSM Tool Now Expedites Prior Authorization and Recommended Clinical Reviews for Behavioral Health services and more - Attend a Training



Blue Cross and Blue Shield of Texas (BCBSTX) continues to streamline the prior authorization and recommended clinical review (RCR) process to reduce your workload with BlueApprovRSM. This new tool in Availity® Essentials will now help you expedite approvals for behavioral health, medical and surgical services and specialty pharmacy drugs for many of our commercial members.

BlueApprovRSM tool offers End-to-End Efficiencies

Registered Availity Essentials users have free, 24/7 access to BlueApprovR tool to:

  • Request RCRs and prior authorization for inpatient and outpatient behavioral health, medical surgical services and specialty pharmacy drugs
  • Secure real-time approvals for certain services and begin treatment right away
  • Easily attach medical records
  • Check approval status of your request

What if I am Prior Authorization exempt?

Providers with active prior authorization exemptions are encouraged to submit a notification through BlueApprovR for services or procedures for which you have a prior authorization exemption. You will also be able to submit recommended clinical reviews through BlueApprovR before moving forward with some services or procedures which are not on the required prior authorization list.  Learn more here.

Note: your RCR submissions will follow the same path through BlueApprovR as Prior Authorization requests. Also, your RCR submission via BlueApprovR replaces the need to FAX or to attach forms in Availity.

Use BlueApprovR to Request Prior Authorization for these Types of Care

  • Behavioral Health
  • Specialty Pharmacy Drugs
  • Inpatient Acute Care
  • Long-term Acute Care
  • Inpatient Rehab
  • Skilled Nursing Facility
  • Outpatient Hospice
  • Inpatient Hospice
  • Home Health
  • Outpatient Service

Provider Training

You can attend an instructor-led, free webinar to learn how to use BlueApprovR. To register, select your preferred date and time from the list below. Times are Central Time:

Nov. 1, 2023 – 11 a.m. to 12:30 p.m.

Nov. 2, 2023 – 1 p.m. to 2 p.m.

Nov. 8, 2023 – 11 a.m. to 12:30 p.m.

Nov. 9, 2023 – 1 p.m. to 2 p.m.

Nov. 15, 2023 – 11 a.m. to 12:30 p.m.

Nov. 16, 2023 – 1 p.m. to 2 p.m.

Nov. 22, 2023 – 11 a.m. to 12:30 p.m.

Nov. 29, 2023 – 11 a.m. to 12:30 p.m.

Nov. 30, 2023 – 1 p.m. to 2 p.m.

How to Submit Prior Authorization and Recommended Clinical Review Requests through Availity Essentials

  • In Availity, select Payer Spaces from the navigation menu, then BCBSTX 
  • On your Payer Spaces page, select the Applications tab and click BlueApprovR
  • Users will be redirected to BlueApprovR to complete the request

Other Prior Authorization Request Methods:

Providers may submit a recommended clinical review utilizing the same submission process as a prior authorization using the Availity® Authorizations and Referrals tool.

Note: This new tool is currently not available for our Federal Employee Program,® Employees Retirement System of Texas, Teachers Retirement System of Texas or Medicare Advantage members. Please use your existing process for requesting prior authorization and recommended clinical review for these members.

Don’t forget – benefits will vary based on the service being rendered. Always check eligibility and benefits first for BCBSTX members to confirm if prior authorization is required. This step also will alert you if your request must be submitted through a vendor, rather than BCBSTX.

Provider Resources

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.