Availity® Authorizations & Referrals

Availity's Authorizations & Referrals tool (HIPAA-standard 278 transaction) allows providers to electronically submit prior authorization requests for inpatient admissions, select outpatient services and referral requests managed by BCBSTX Medical Management. Additionally, providers can also check status on previously submitted requests and/or update applicable existing requests.

Benefits of using this online functionality:

  • No separate user enrollment needed
  • Direct access within Availity Essentials
  • Simplified 5-step process

How to access and use Availity Authorizations & Referrals:

  1. Log in to Availity 
  2. Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations*
  3. Select Payer BCBSTX, then choose your organization
  4. Select a Request Type and start request
  5. Review and submit your request

*Choose Referrals instead of Authorizations if you are submitting a referral request.

For additional details, refer to the Authorizations User Guide and Referrals User Guide.

Important Tips:

  • Check eligibility and benefits online first to determine if prior authorization is required for the service and/or procedure code(s). To learn more about checking eligibility and benefits via Availity, refer to the General Eligibility and Benefits User Guide.
  • Authorizations managed by AIM Specialty Health® (AIM) are handled through the AIM portal
  • Authorizations managed through eviCore healthcare® (eviCore) will continue to be handled through the eviCore portal.
  • Predetermination requests may be submitted via Availity using Availity Attachments or by fax or mail using the appropriate form in the Forms section.

Providers who are not yet registered with Availity, can sign up today at Availity, at no charge. If you need registration assistance, contact Availity Client Services at 1-800-282-4548.

Questions?

Email our Provider Education Consultants. Be sure to include your name, direct contact information, Tax ID and/or Billing NPI.

 

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member's ID card.

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. 

eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. eviCore is wholly responsible for its own products and services. 

AIM Specialty Health is an independent medical benefits management company that provides utilization management services for BCBSTX..

BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as Availity, AIM or eviCore.