New Uniform Managed Care Manual Chapter 16.9 Published


What’s New

Blue Cross and Blue Shield of Texas would like to make providers aware that the new UMCM chapter 16.9 serves as a guidance regarding Durable Medical Equipment, a covered service under the managed care contracts. Provisions of the new chapter include:

  • Provider can allow prior authorization recertification of medical equipment, supplies, and appliances for up to twelve months after the initial six months approval.
  • Prior authorization recertification change from every six months to twelve months is applicable to all Medicaid managed care programs except dental benefits.
  • The frequency of reviewing the need for medical equipment, supplies, and appliances will be determined on a case-by-case basis by a requesting physician or allowed practitioner based on the nature of the member’s condition and the item prescribed.

BCBSTX will accept both Title XIX form and the Texas Department of Insurance forms, as long as it has all required elements to build the authorization along with the appropriate clinical documentation to support medical necessity.


Providers, for questions or additional information, please: