Announcing eviCore To Begin New Preauthorization Requirements for Blue Choice PPOSM, and Blue PremierSM
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 August 1, 2017, eviCore will manage pre-service authorization for the following specialized clinical services:
- Molecular and genomic testing
- Radiation oncology for all outpatient and office services
The new preauthorization requirements apply to the Blue Choice PPO, Blue Premier and Blue Premier Access fully insured members* (identified by TDI listed on their membership card). This is in addition to Blue Advantage HMO which began using eviCore effective October 3, 2016.
The updated Blue Choice PPO or Blue Premier and Blue Premier Access Preauthorization / Referral Requirements Lists, that includes the services listed above which require preauthorization through eviCore, for dates of service beginning August 1, 2017 are located on the Provider website at bcbstx.com/provider under the Clinical Resources page. Services performed without authorization may be denied for payment, and you may not seek reimbursement from members/subscribers.
Preauthorization's for the above services through eviCore can be obtained using one of the following methods:
- The eviCore Healthcare Web Portal is available 24x7. After a one-time registration, you can initiate a case, check status, review guidelines, view authorizations/eligibility and more. The Web Portal is the quickest, most efficient way to obtain information.
- Providers can call toll-free at 855-252-1117 between 6 a.m. to 6 p.m. (central time) Monday through Friday and 9 a.m.- noon Saturday, Sunday and legal holidays.
For all other services that require a referral, and/or preauthorization, as noted on the preauthorization / referral requirements list, you will continue to use iExchange®. iExchange is accessible to physicians, professional providers and facilities contracted with BCBSTX. You can learn more information about iExchange or set up a new account on the Provider website.
If you have any questions, you may contact your Network Management Representative.
*At this time, the eviCore preauthorization requirement does not include Administrative Services Only (ASO) members
As a reminder, it is important to check eligibility and benefits prior to rendering services. This step will help you determine if benefit preauthorization is required for a particular member. For additional information, such as definitions and links to helpful resources, refer to the Eligibility and Benefits section on BCBSTX's provider website.
Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits 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 questions, contact the number on the member's ID card.