Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

November 2017

Requesting Predetermination of Benefits

As a reminder, predetermination of benefits requests may be submitted electronically to Blue Cross and Blue Shield of Texas (BCBSTX) through iExchange®, our online benefit preauthorization and predetermination of benefits tool. Providers may also upload attachments, check status and obtain online approval information via iExchange. This online tool is available to physicians, professional providers and facilities contracted with BCBSTX. iExchange may be accessed directly or through the Availity™ Web Portal and is designed to help save you time by reducing the amount of calls and written inquiries submitted to BCBSTX.

If you need to submit a paper predetermination of benefits request to BCBSTX, it is important to send the pertinent medical documentation using our Predetermination Request Form. This form and others are available in the Education & Reference Center/Forms section on the BCBSTX provider website.

Beginning Dec. 1, 2017, written predetermination requests must be submitted using the Predetermination Request Form. Beginning Jan. 1, 2018, paper requests that are received by BCBSTX without the Predetermination Request Form will be returned to the submitting provider, along with instructions to resend the request using the appropriate form.

Checking eligibility and benefits is always an important first step, prior to submitting predetermination of benefits and other pre-service requests. Eligibility and benefits requests may be submitted electronically through Availity or your preferred web vendor. Predetermination of benefits requests are not a substitute for the eligibility and benefits process.

To learn more about iExchange and other electronic options, visit the Provider Tools section in our online Education & Reference Center. For personalized online training regarding electronic tools, contact our Provider Education Consultants at PECS@bcbstx.com.

Note: This information does not apply to Blue Cross Medicare Advantage (HMO)SM or Blue Cross Medicare Advantage (PPO)SM members.