July 1, 2025
We’ve reviewed some prior authorization exemptions for particular health care services in effect prior to March 2025 to determine if the prior authorization exemption can continue.
If your prior authorization exemption was rescinded, you will be required to submit requests for prior authorizations for this particular service as of the rescission effective date on your notice.
To view the latest notices: Refer to the Provider Correspondence Viewer in Availity® Essentials’ payer spaces for Blue Cross and Blue Shield of Texas. If you requested alternate methods for your prior authorization exemption communications, the results will be communicated through those channels.
Review method: We randomly selected at least five claims processed after your prior authorization exemption was in effect.
- If at least 90% of those claims were medically necessary, then the prior authorization exemption will be renewed for that particular service.
- If we found less than 90% of those claims were medically necessary, your prior authorization exemption will be rescinded.
If you disagree with the decision: You may request a review by an independent review organization via fax at 972-907-1868 or mail (PO Box 660044 Dallas, TX 75266). The request must be received before the rescission date on the notice.
If you have a prior authorization exemption in effect, we encourage you to submit a notification to prevent post service medical necessity reviews. You can submit the notification through Availity® Authorizations & Referrals or by calling the number on the member’s ID card.
Refer to the Prior Authorization Exemptions page for additional information.
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.