June 14, 2021
What’s New: Blue Cross and Blue Shield of Texas (BCBSTX) will be updating its lists of procedure codes requiring prior authorization by AIM Specialty Health® (AIM), for some commercial members. These changes reflect new, replaced or removed codes due to updates from Utilization Management (UM) or the American Medical Association (AMA).
More Information: Refer to the Utilization Management section of our provider website for revised lists under the Prior Authorization Lists for Fully Insured and Administrative Services Only (ASO) Plans.
- May 21, 2021 – Removal of Pain Management codes previously reviewed by AIM (UM change)
- July 1, 2021 – Adding Genetic Testing codes to be reviewed by AIM (AMA update)
Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity® or your preferred vendor.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
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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 BCBSTX.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSTX to provide utilization management services for members with coverage through BCBSTX.
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.