Blue Cross and Blue Shield of Texas (BCBSTX) has contracted with eviCore healthcare (eviCore), an independent specialty medical benefits management company, to provide Utilization Management services for new preauthorization requirements (outlined below).
Effective Oct. 3, 2016, eviCore will manage pre-service authorization for the following specialized clinical services:
These new preauthorization requirements apply to the Blue Advantage HMOSM (and Blue Advantage PlusSM HMO product) provider networks.
The updated Blue Advantage HMO and Blue Advantage Plus HMO Preauthorization/Referral Requirements list has been updated to include the services listed above that require preauthorization through eviCore, for dates of service beginning Oct. 3, 2016. The updated preauthorization list will be located on the provider website at bcbstx.com/provider under the Standards & Requirements tab and General Reimbursement Information section. Services performed without authorization may be denied for payment, and you may not seek reimbursement from members.
For all other services that require a referral and/or preauthorization, as noted on the Preauthorization/Referral Requirements list, you will continue to use iExchange®. iExchange is accessible to physicians, professional providers and facilities contracted with BCBSTX. For more information or to set up a new iExchange account, please go to bcbstx.com/provider/tools/iexchange.html.
BCBSTX and eviCore will be providing additional information in the coming weeks on the provider website at bcbstx.com/provider and in Blue Review, including:
You may also contact your Network Management consultant for more information.