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 that are outlined below.
Providers should contact eviCore to request preauthorization for Blue Advantage HMOSM and Blue Advantage PlusSM HMO members for services rendered on and after Oct. 3, 2016, for:
eviCore preauthorization’s for outpatient molecular and genomic testing and outpatient radiation therapy can be obtained using one of the following methods:
The 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 preauthorization list is located under Standards & Requirements/General Reimbursements on the BCBSTX provider website. 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 visit Getting Started with iExchange.
BCBSTX and eviCore will be providing additional information in the coming weeks on the provider website and in Blue Review, including:
Refer to eviCore Preauthorization Program for more information. You may also contact your Network Management consultant for more information.