March 2017
Changes in Prior Authorization Process Effective June 1, 2017
Blue Cross and Blue Shield of Texas (BCBSTX) is making changes to the prior authorization process, effective June 1, 2017. BCBSTX has contracted with eviCoreTM healthcare (eviCore), an independent specialty medical benefits management company, to provide prior authorization for expanded outpatient and specialty utilization management for BCBSTX Medicaid members (STAR, STAR Kids and CHIP).
Effective June 1, 2017, eviCore will manage pre-service authorization for the following specialized clinical services:
- Outpatient Molecular Genetics
- Outpatient Radiation Therapy
- Musculoskeletal
- Chiropractic
- Physical and Occupational Therapy
- Speech Therapy
- Spine Surgery (Outpatient/Inpatient)
- Spine Lumbar Fusion (Outpatient/Inpatient)
- Interventional Pain
- Outpatient Cardiology and Radiology
- Pediatric Abdomen Imaging
- Pediatric Cardiac Imaging
- Pediatric Chest Imaging
- Pediatric Head Imaging
- Pediatric Musculoskeletal Imaging
- Pediatric Neck Imaging
- Pediatric Oncology Imaging
- Pediatric Pelvis Imaging
- Pediatric Peripheral Nerve Disorders (Pnd) Imaging
- Pediatric Peripheral Vascular Disease (Pvd) Imaging
- Pediatric Spine Imaging
- Abdomen Imaging
- Cardiac Imaging
- Chest Imaging
- Cardiac Rhythm Implantable Device (Crid)
- Head Imaging
- Musculoskeletal
- Neck Imaging
- Obstetrical Ultrasound Imaging
- Oncology Imaging
- Pelvis Imaging
- Peripheral Nerve Disorders (Pnd) Imaging
- Peripheral Vascular Disease (Pvd) Imaging
- Spine Imaging
- Outpatient Medical Oncology
- Outpatient Sleep
- Post-acute Care
- Outpatient Specialty Drug
eviCore will have a dedicated portal for online requests, such as are currently available with AvailityTM and iExchange®. Dedicated fax and telephone numbers will also be available via eviCore. Services performed without preauthorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
You will continue to use current telephone and fax numbers as well as Availity and iExchange for all other services (not listed above) that require preauthorization.
BCBSTX and eviCore will be providing additional information, including training opportunities, in the coming months on the BCBSTX provider website and in this newsletter.
Our goal is always to provide our members with access to quality health care. If you have any questions, please contact your Provider Network Representative at 855-212-1615 for assistance.
eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSTX.
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. Aerial, iExchange and Medecision® are trademarks of Medecision, Inc., a separate company that offers collaborative health care management solutions for payers and providers. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by Availity or Medecision. 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.