Prior Authorization and Referrals

Doctors and Hospital

When picking a doctor, you do not need an authorization for an in-network doctor. If you want to see a Medicaid doctor out of network, work with your service coordinator so arrangements are made to get authorizations for your out-of-network provider. To learn more about how to select a primary care provider (PCP), please refer to the STAR Kids Member Handbook.

Do you need help getting to a medical appointment? Check transportation services.

You can also contact your service coordinator with any questions or concerns.

  • Your right to protect your needs, and understand the information and care you receive
  • Your responsibility to give your providers the information they need to take care of you
  • How to file a complaint
  • How to report health care fraud

If you have questions, please call Service Coordination toll-free at 1-877-301-4394.

Prior Authorization and Referrals

Prior authorizations are not needed for in-network PCPs or other providers. Your child's PCP may send you to a different provider, including a specialist, for special care or treatment. A referral to an in-network specialist is not needed. Blue Cross and Blue Shield of Texas will allow members to see out-of-network Medicaid specialists for medically necessary services.

OB/GYN Providers

BCBSTX also allows members to see out- of-network OB/GYN providers for medically necessary services. You should notify a service coordinator if you are going to see an out of network OB/GYN to ensure that the provider is loaded in our system so that they can file claims.

Behavioral Health and Substance Abuse Treatment Services

You do not need a referral for behavioral health or substance abuse treatment services to see a behavioral health provider. If you want to see an out-of-network provider, you need to get a prior authorization to ensure the provider has the information needed to accurately pay claims. A Service Coordinator will work with your child’s service coordinator to ensure your child has access to the behavioral health services needed. You can also call your BCBSTX Service Coordinator at 1-877-301-4394.

Emergency Care and Urgent Care

Emergency or urgent care does not require authorization. You do not need an OK from us or need a referral from your PCP to see a family planning care provider. You can contact your child's service coordinator for help scheduling an appointment at 1-877-301-4394 or call the Customer Advocate Department at 1-877-688-1811.

Applied Behavioral Analysis for Children with Autism Spectrum Disorder

Applied Behavioral Analysis (ABA) therapy is now a benefit for STAR Kids members as a covered benefit through Texas Medicaid. ABA can help children with Autism Spectrum Disorder (ASD) develop improved function with their peers and caregivers. To qualify for ABA, your child must first have special testing to confirm their diagnosis of ASD. 

ABA testing is more thorough than what most pediatricians can do as part of their practice. The testing must be performed by a specialist such as a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an Autism diagnosis team. Speak to your child’s pediatrician about getting a referral to one of these specialists.

Please check the ABA therapy Frequently Asked Questions for more information.

Go to Provider Finder® to search for and print a list of ABA providers in your area.

If you have more questions about ABA services, please call BCBSTX STAR Kids Service Coordination toll-free at 1-877-301-4394. Members with hearing or speech loss can call the TTY line at 711.

Learn How Your Plan Works

To learn more about prior authorization and referrals, check the Member Handbook.

Find a Doctor or Hospital 

Use our Provider Finder® to search for doctors and other health care providers near you.

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