2024 Prior Authorization Exemption Renewal Results


Some prior authorization exemptions for particular healthcare services in effect prior to March 2024 have been reviewed to determine if the PA Exemption can be continued. As of June 30, 2024, you can check to see if your PA Exemption was reviewed for continuation.

As per Texas HB3459, we randomly selected at least 5 claims processed after the PA exemption was in effect and if at least 90% were medically necessary, then the PA exemption will be renewed for that particular health care service.  

If the claim review resulted in less than 90% medically necessary, a rescission notice for your PA Exemption was issued and is available on Availity® Payer Spaces in the Provider Correspondence Viewer. (If you provided a PA exemption alternate communication method (email/mail), your notice was also sent via that method.)

Remember, a request for an independent review organization, to review a PA exemption being rescinded, can be submitted via fax at 1-972-907-1868 or mail (PO Box 660044 Dallas, TX 75266) but it must be received before the rescission date on the notice. If your PA exemption was rescinded, you will be required to submit requests for prior authorizations for this particular service as of the rescission effective date on your notice.

If the provider was reviewed and met the 90% threshold, the PA Exemption will be maintained, and a courtesy notice will be available in Availity by June 30, 2024 or sent by the providers preferred communication method.  As a reminder, if you have a PA exemption in effect, you are encouraged to submit a notification to prevent post service medical necessity reviews. They can be submitted via Blue ApprovRSMAvaility® Authorizations & Referrals or by calling the number on the back of the ID card.

For more information, refer to the Prior Authorizations Exemptions page on the provider website. 

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