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Blue Cross and Blue Shield of Texas has developed medical policies that serve a basis for some coverage decisions. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to all applicable state and/or federal law. Medical policy does not constitute plan authorization, nor is it an explanation of benefits.
Medical policies can be highly technical and complex and are provided here for informational purposes. The medical policies do not constitute medical advice or medical care. Treating health care providers are solely responsible for diagnosis, treatment and medical advice.
Medical technology is constantly evolving and these medical policies are subject to change. Additional medical policies may be developed from time to time and some may be withdrawn from use. The medical policies generally apply to all Blue Cross and Blue Shield of Texas fully insured benefit plans. Some benefit plans administered by Blue Cross and Blue Shield of Texas, such as some self-funded employer plans or governmental plans, may not utilize Blue Cross and Blue Shield of Texas medical policies. Providers should contact the provider customer service area for specific coverage information.
Blue Cross and Blue Shield of Texas medical policies and other general reimbursement policies are routinely reviewed. When it is determined new policies or updates to existing policies are required Blue Cross and Blue Shield of Texas will implement the policy for initial claims adjudicated on or after the effective date of such policy.
Blue Cross and Blue Shield of Texas medical policies and other general reimbursement policies are not applicable to health plans administered or issued by other Blue Cross and Blue Shield companies.
Blue Essentials providers who are contracted/affiliated with a capitated IPA/medical group must contact the IPA/medical group for information regarding HMO claims/reimbursement information and other general policies and procedures. Blue Essentials claims that are processed by a capitated IPA/medical group are subject to the claims/reimbursement and other general policies and procedures of the IPA/medical group.
I have read the above information.