City of Austin Member Preauthorization Changes
There are important changes to the preauthorization requirements for your Blue Cross and Blue Shield of Texas (BCBSTX) patients who are City of Austin members with one of the following employer group numbers 246681, 246682, 246683 or 246684 on their BCBSTX identification cards.
Effective immediately, preauthorizations for City of Austin members are no longer provided through eviCore healthcare. Some of these services instead may require a Radiology Quality Initiative (RQI) through AIM Specialty Health®(AIM).
Therefore, going forward, it is imperative to use Availity® or your preferred vendor to check eligibility and benefits, determine if you are in-network for your patient and whether any preauthorization or prenotification is required. Availity allows you to determine if preauthorization is required based on the procedure code. Refer to “Eligibility and Benefits” on the provider website for more information on Availity. Providers can also refer to the Preauthorizations/Notifications/Referral Requirements page for assistance.
For a list of the services now requiring an RQI through AIM, refer to the AIM page on the BCBSTX provider website. The ordering physician may obtain an RQI and the rendering provider may verify that an RQI has been issued by logging on to the AIM Provider Portal or by calling AIM at 866-455-8415.
For other services requiring preauthorization through BCBSTX, continue to use iExchange® to preauthorize those services. For more information or to set up an iExchange account, please go to the iExchange page.
Payment may be denied if you perform procedures without authorization. If this happens, you may not bill your patients.
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 are 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 the number on the member’s ID card.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. eviCore is a wholly responsible for its own products and services. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by eviCore.
AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third-party vendor that is solely responsible for its products and services.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Texas.
iExchange is a trademark of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers.
BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity, eviCore, AIM or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.