Update to the BCBSTX Predetermination Request Form

June 15, 2018

Blue Cross and Blue Shield of Texas (BCBSTX) providers can submit requests for Predeterminations through iExchange® , the preferred method, or by submitting the Predetermination Request Form-Medical Surgical. An updated Predetermination form has been posted to the BCBSTX provider website that includes changes to the Member Data and Documentation sections. These changes will enable the collection of important information such as drug names and dosing information. In addition, the form’s procedure code fields will capture units.

If you cannot submit your Predetermination electronically through iExchange, you should begin utilizing the updated Predetermination form immediately, The form is located on the provider website under Education and Reference/Forms. As of October 1, 2018, if you use the paper form, you must submit your predeterminations using the new form (indicates 729617.0318 on the bottom of form), otherwise, your predetermination request will be rejected and you will be required to resubmit it using the new form.

If you submit your Predetermination requests electronically using iExchange , please add the following information in the Additional Notes section of the iExchange predetermination form:

  • Drug Name
  • Dose/Frequency/Duration
  • Units

For assistance on submitting Predeterminations electronically through iExchange, refer to the Tip Sheets on the BCBSTX iExchange page.

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