Jan. 30, 2026
We’ve reviewed some prior authorization exemptions for particular health care services in effect for at least one year to determine if the prior authorization exemption can continue.
To view the results: 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- If we found less than 90% of those claims were medically necessary, your prior authorization exemption will be rescinded.
Note: for the privacy of our members the claim number has been de-identified. If you need the complete claim detail, please complete the Prior Authorization Exemption Inquiry Form and email it back to us with a copy of your rescission letter.
If your prior authorization exemption was rescinded, you will be required to submit requests for prior authorizations for this particular service as of the rescission effective date on your notice.
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.
Reminder: If your prior authorization exemption remains in effect, we encourage you to request a notification to BCBSTX for your prior authorization exempted services to determine if the service or item is covered under the member’s benefit plan and confirm the initial length of stay or initial units covered by the exemption. Services beyond the initial length of stay or units covered by the prior authorization exemption may be reviewed for medical necessity if it is not prior authorized. 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.