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

June 2017

BCBSTX New Employer Group Plan – Employees Retirement System of Texas (ERS) Effective Sept. 1, 2017

We are excited to announce that Blue Cross and Blue Shield of Texas (BCBSTX) was awarded the six-year contract for the Employees Retirement System of Texas (ERS) account, effective Sept. 1, 2017. ERS participants covered under HealthSelectSM of Texas and Consumer Directed HealthSelectSM benefit plans will access care through the Blue EssentialsSM provider network in all 254 counties in Texas.

ERS participant plan options:

  1. HealthSelect of Texas In-area (Texas)
    • Participants must select a primary care physician (PCP) participating in the Blue Essentials provider network and referrals are required to see Blue Essential providers for in-network benefits.
  2. Consumer Directed HealthSelect In-area (Texas)
    • Consumer Directed HealthSelect participants have open access to providers in the Blue Essentials provider network for their in-network benefits. This plan does not require PCP selection and does not require referrals.

ERS participants can be identified through their BCBSTX ID card:

  • The plan names HealthSelect of Texas and Consumer Directed HealthSelect will be printed directly on the ID card
  • ERS participants will have a unique Blue Essentials network ID labeled HME

Patient eligibility and benefits should be verified prior to every scheduled appointment. Eligibility and benefit quotes include participant verification, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. It’s strongly recommended that providers ask to see the participant’s ID card for current information and photo ID to guard against medical identity theft. When services may not be covered, participants should be notified that they may be billed directly.

For a list of services that require prior authorization for ERS participants, refer to the ERS HealthSelect Prior Authorization/Notification/Referral Requirements List or ERS Consumer Directed Health Select Prior Authorization/Notification/Referral Requirements List on the Clinical Resources page of BCBSTX’s provider website.

In addition, BCBSTX has contracted with eviCoreTM healthcare (eviCore), an independent specialty medical benefits management company, to provide utilization management services for the prior authorization requirements outlined below. The requirements are also indicated on the HealthSelect or Consumer Directed HealthSelect Prior Authorization/Notification/Referral Requirements lists for ERS participants.

  • Molecular and genomic testing
  • Radiation oncology for all outpatient and office services
  • Advanced radiology imaging
  • Sleep studies and sleep durable medical equipment

To obtain prior authorization through eviCore you may use one of the following methods:

  • Use the eviCore healthcare web portal, which is available 24/7. After a one-time registration, you can initiate a case, check status, review guidelines, view authorizations and eligibility, and more. The web portal is the quickest, most efficient way to obtain information.
  • Call eviCore at 855-252-1117 toll-free between 6 a.m.-6 p.m. (CT), Monday through Friday, and 9 a.m.-noon (CT), Saturday, Sunday and legal holidays.

For all other services (not listed above) that require a referral and/or prior authorization, providers should refer to the telephone numbers on participants' ID cards, or physicians, professional providers and facilities contracted with BCBSTX can access iExchange®. Go to iExchange to learn more or set up a new account.

Watch for additional information regarding ERS in future editions of this newsletter and on BCBSTX’s provider website.

If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.