08/27/2024
As announced on May 31, 2024, Blue Cross and Blue Shield of Texas is moving prior authorization to Recommended Clinical Review Option for outpatient services for Teacher Retirement System of Texas Administrative Services Only participants. Inpatient services were previously moved to RCR. Outpatient prior authorization for fully insured TRS plans is not changing. Fully Insured plans will indicate “TDI” on their ID card.
Providers can refer to the Teacher Retirement System of Texas Recommended Clinical Review list on the provider website for the services applicable to RCR.
Providers are encouraged to submit an RCR for services that previously required prior authorization to prevent post service medical necessity reviews.
For More Information
Refer to the RCR page for information on RCR services and how to submit requests for services managed by BCBSTX or Carelon.
Learn more about our utilization management process, including prior authorization and recommended clinical review in the Utilization Management section of our provider website. Follow our News and Updates page for future updates.
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