ERS Prior Authorization Requirement Update – 491 Outpatient Procedures Removed

April 13, 2018

Blue Cross and Blue Shield of Texas (BCBSTX) has been closely monitoring the Prior Authorization requirements to ensure proper protocols are in place. After receiving feedback from the provider community, BCBSTX has reviewed the Employee Retirement System of Texas’ (ERS) HealthSelectSM of Texas and Consumer Directed HealthSelectSM prior authorization requirements which resulted in the removal of 491 outpatient procedures retroactively effective September 1, 2017. Providers should refer to the “ERS Outpatient Procedures No Longer Requiring Prior Authorization” list under Preauthorizations/Notifications/Referral Requirements on the provider website for a list of the codes being removed.

BCBSTX will be reviewing applicable claims that denied for lack of Prior Authorization and claims that include any of the 491 outpatient procedures that no longer require Prior Authorization and they will be adjusted as appropriate for payment. Additionally, BCBSTX will review any appeals and grievances to determine if an appeal or grievance is no longer appropriate.

For a list of all the prior authorization and referral requirements for ERS participants, refer to Preauthorizations/Notifications/Referral Requirements on the provider website.

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