May 2017
Changes in Prior Authorization Process Effective June 1, 2017
Effective June 1, 2017, Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the prior authorization process. 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). Training sessions begin Monday, May 15, 2017, and run through Wednesday, May 31, 2017.
eviCore will manage pre-service authorization for the following specialized clinical services in the following categories:
- Cardiology
- Lab
- Medical Oncology/Specialty Drug
- Musculoskeletal - Joint, Spine and Pain
- Musculoskeletal -Therapies
- Radiation Therapy
- Radiology
- Sleep
As we near June 1, the BCBSTX Medicaid Network Department will provide service and education on the prior authorization process to the following provider types:
- Family practice
- General practitioner
- Neurology
- Endocrinology
- Rheumatology
- Hematology/oncology
- Nephrology
- Gastroenterology
- Dermatology
BCBSTX and eviCore will be providing additional information at bcbstx.com/provider and in this newsletter.
Other Information
eviCore will have a dedicated web portal for online requests like what is currently available with AvailityTM and iExchange®. Dedicated fax and telephone lines 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.
Providers 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.
Our goal is always to provide our members with access to quality health care. If you have any questions, please contact your Medicaid 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, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. iExchange is a trademark 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 third party vendors such as Availity or Medecision. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.