March 1, 2025
We’ve reviewed providers for prior authorization exemptions per Texas HB3459 for the July 1 through Dec. 31, 2024, review period. To view the latest notices, refer to the Provider Correspondence Viewer in Availity® Essentials’ payer spaces for Blue Cross and Blue Shield of Texas.
Pharmacy exemptions: Prior authorization exemption status for any prior authorization managed by a pharmacy benefit manager is handled and conveyed by the PBM.
Notification acknowledgements: If you have qualified for a prior authorization exemption, submit a notification to BCBSTX to determine the initial length of stay or initial units exempted for services. Services rendered beyond the initial length of stay or units covered by the exemption may be reviewed for medical necessity.
Submit notification through Availity Essentials or by calling the number on the member’s ID card. You’ll receive a notification acknowledgement for the specific services allowable per the prior authorization exemption.
Concurrent review is still required for ongoing or extension of services beyond care guidelines.
See our prior authorization exemptions page for details on:
- How exemption statuses are evaluated
- Accessing your exemption status notifications
- Questions or appeals
- Exempted services or codes applicable to the care category on your notification
Learn more about prior authorizations on our utilization management page.
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