2018 Updates to the Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM Preauthorization Lists
This notice has been updated to include a change to the BCBSTX Medicare Advantage CPT Preauthorization Code List.
Blue Cross and Blue Shield of Texas (BCBSTX) has updated the list of procedures requiring preauthorization for our Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) plans. Both updated preauthorization lists will be effective January 1, 2018. If you are not participating in the Blue Cross Medicare Advantage (PPO) network or Blue Cross Medicare Advantage (HMO) network, disregard the information pertaining to that plan.
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. To authorize services requiring preauthorization through eviCore, you can go to eviCore.com or call 855-252-1117.
Preauthorization/Referral Requirements Lists are attached and have been updated to include the services that require preauthorization through BCBSTX and eviCore. The updated preauthorization lists will be located on bcbstx.com/provider under Clinical Resources. For specific codes that apply,refer to the BCBSTX Medicare Advantage CPT Preauthorization Code List which was updated with a change to no longer require preauthorization for the initial evaluation for procedure codes 97161-97163 and 97165-97167, Requests for preauthorization for ongoing care may be submitted as early as 7 days prior to the requested start date.
As a reminder, iExchange, our automated referral and preauthorization tool, is available 24 hours a day, seven days a week (with the exception of every third Sunday of the month when the system will be unavailable from 11 a.m. to 3 p.m. CT) for those services requiring preauthorization through BCBSTX. iExchange is accessible to physicians, professional providers and facilities contracted with BCBSTX. For more information or to set up a new account, complete and submit the iExchange online enrollment form.
Failure to timely notify BCBSTX and obtain pre-approval for listed procedures may result in denial of the claim(s) for care services, which cannot be billed to the member pursuant to your provider agreement with BCBSTX.
If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.