Announcing eviCore To Begin New Preauthorization Requirements for Blue EssentialsSM and Blue Essentials AccessSM

May 26, 2017

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 September 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
  • Advanced Radiology Imaging
  • Sleep Studies and Sleep Durable Medical Equipment

These new preauthorization requirements apply to the Blue Essentials (formerly HMO Blue Texas) provider network for Blue Essentials and Blue Essentials Access fully insured members* (identified by TDI listed on their membership card).

*At this time, the eviCore preauthorization requirement does not include Administrative Services Only (ASO) members.

The Blue EssentialsSM (formerly known as HMO Blue Texas) and Blue Essentials AccessSM Preauthorization/Referral Requirements Lists have been updated to include the services listed above that require preauthorization through eviCore, for dates of service beginning September 1, 2017. The updated preauthorization lists will be located on the Clinical Resources page. Services performed without authorization may be denied for payment, and you may not seek reimbursement from members.

Preauthorization's for the above services through eviCore can be obtained using one of the following methods:

  • The eviCore Healthcare Web Portal Learn more about third-party links 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.

Check the BCBSTX provider website and the Blue Review in the coming weeks, for additional information from BCBSTX and eviCore including training opportunities.

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