New Preauthorization Requirements through eviCore

June 28, 2016

Blue Cross and Blue Shield of Texas (BCBSTX) has contracted with eviCore healthcare (eviCore), an independent specialty medical benefits management company to provide Utilization Management services for new preauthorization requirements outlined below.

Effective October 3, 2016, eviCore will manage pre-service authorization for the following specialized clinical services:

  • Molecular and genomic testing
  • Radiation oncology for all outpatient and office services

These new preauthorization requirements apply to the Blue Advantage HMOSM (and Blue Advantage PlusSM HMO product) provider network.

The updated Blue Advantage HMOSM and Blue Advantage PlusSM HMO Preauthorization / Referral Requirements List PDF Document has been updated to include the services listed above that require preauthorization through eviCore, for dates of service beginning October 3, 2016. The updated preauthorization list will be located on the General Reimbursement Information page. Services performed without authorization may be denied for payment, and you may not seek reimbursement from members.

For all other services that require a referral, and/or preauthorization, as noted on the preauthorization / referral requirements lists, you will continue to use iExchange®. iExchange is accessible to physicians, professional providers and facilities contracted with BCBSTX. Learn more information or set up a new iExchange account.

BCBSTX and eviCore will be providing additional information in the coming weeks, on the Provider website and in Blue Review, including:

  • Training opportunities/webinars
  • How to register with eviCore on their website
  • eviCore phone and fax number

If you have any questions you may contact your Network Management Representative.