iExchange® Deactivation Aug. 17, 2020
The deactivation of our current electronic prior authorization, referral and predetermination of benefits request tool, iExchange is August 17, 2020. As of this date, all electronic prior authorization, referral and predetermination requests handled by Blue Cross and Blue Shield of Texas (BCBSTX) should be submitted online via the Availity® Provider Portal using Availity Authorizations & Referral tool.
Submitting Online Prior Authorization and Referral Requests
You can submit required requests for prior authorizations for inpatient and outpatient services managed by BCBSTX medical management and outpatient referrals online using Availity’s Authorizations & Referrals tool. Refer to the educational Availity Authorizations User Guide and Availity Referrals User Guide located in the Provider Tools section of our website for navigational assistance. Prior authorization requests managed by eviCore healthcare® (eviCore), AIM Specialty Health® or other vendors through their provider portals or channels has not changed.
It’s imperative to check the patient’s eligibility and benefits online first to determine if the service requires prior authorization. For online assistance, refer to the General Eligibility and Benefits Expanded User Guide .
How to Submit Online Predetermination of Benefits Requests
As of July 30, 2020, predetermination of benefit requests handled by BCBSTX can be submitted electronically using Availity’s Attachments tool. Watch for the new Electronic Predetermination Request user guide coming soon to the Provider Tools section and refer to the Predetermination of Benefits page for more information.
If you don’t have online access, you may continue to fax and/or mail predetermination requests along with a completed Predetermination Request Form and supporting medical documentation. If faxing supporting medical documentation for a previously submitted request, please include the request number.
Submitting predetermination of benefits via Availity does not apply to requests for Texas Medicaid or Medicare Advantage members.
For More Information
You must be registered with Availity to use the Authorizations and Attachments tools. You can sign up today at Availity , at no charge. For registration assistance, call Availity Client Services at 800-282-4548. Training sessions are also available on our Educational Webinar/Workshop Sessions page.
If you need further assistance or customized training for these Availity solutions, contact our Provider Education Consultants.
Please note that the fact that a service has been preauthorized/pre-notified that a guideline is available for any given treatment or that a service or treatment has been 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 any questions, call the number on the member’s ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. eviCore is wholly responsible for its own products and services.
BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity, eviCore or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.