New Preauthorization Requirements for Blue Choice PPOSM H-E-B members
Blue Cross and Blue Shield of Texas (BCBSTX) has updated the Blue Choice PPO Self Insured (without health advocacy solutions) preauthorization list to include a preauthorization requirement for Non-Emergent Air Ambulance for H-E-B members only (identified by Group # 091043) effective June 1, 2018.
An updated Blue Choice PPO Self Insured Groups (without health advocacy solutions) Preauthorization/Notifications/Referral Requirements List which includes the services listed above that require preauthorization for H-E-B members only for dates of service beginning June 1, 2018 is located on the provider website under Preauthorization/Notifications/Referral Requirements. Services performed without authorization may be denied for payment and you may not seek reimbursement from members/subscribers.
Providers can use iExchange® to preauthorize the non-emergent air ambulance services. iExchange is accessible to all physicians, professional providers and facilities. For more information or to set up a new iExchange account, please go to the iExchange page on the BCBSTX provider website.
If you have any questions, please contact your BCBSTX Network Management Representative.
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 BCBSTX Provider Customer Service at 1(800)451-0287.