New Prior Authorization Requirements for Blue Choice PPOSM H-E-B Members Only Effective Jan. 1, 2019

Sept. 24, 2018

Updated 10/5/2018

Blue Cross and Blue Shield of Texas (BCBSTX) is updating the prior authorization requirements for Blue Choice PPO H-E-B members only (Group 091043), to include prior authorization for Knee/Hip/Spine, Genetic Testing, Sleep Studies, and Specialty Drugs.

BCBSTX has posted an H-E-B Members Only Additional Prior Authorization Procedure Code List of the specific procedure codes impacted for this change effective 1/1/2019 on the provider website under Clinical Resources/ Prior Authorizations/Notifications/Referral Requirements.

Services performed without authorization may be denied for payment and you may not seek reimbursement from the member.

Providers can use iExchange® to preauthorize services including the additional services listed above. iExchange is accessible to physicians, professional providers, and facilities. Find more information about iExchange or to how to set up a new account under Clinical Resources on the 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 prior authorization is required for a 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 the number on the member’s ID card.