If you're a Blue Cross Blue Shield Texas member, you're likely familiar with the term "prior authorization." This process ensures that the treatments and medications you need are medically necessary and won't be covered by your insurance plan.
Blue Cross Blue Shield Texas has a prior authorization process in place to review and approve or deny requests for certain treatments and medications. This process typically involves submitting a request to your doctor or healthcare provider, who will then submit the request to Blue Cross Blue Shield Texas for review.
Your healthcare provider may need to provide additional information to support your request, such as medical records or test results. This information will be used to determine whether the treatment or medication is medically necessary and meets the insurance plan's requirements.
The prior authorization process can take anywhere from a few days to several weeks, depending on the complexity of your case and the volume of requests being processed.
You might enjoy: United Healthcare Prior Authorization Radiology
Prior Authorization Process
The prior authorization process for Blue Cross Blue Shield Texas can be a bit lengthy, but understanding the steps involved can help you navigate it more efficiently.
Prior authorization is required for certain medical services and treatments, such as those that are experimental or not medically necessary.
You can submit a prior authorization request through Blue Cross Blue Shield Texas' online portal, by phone, or by mail.
Requests typically take 2-3 business days to process, but this timeframe may vary depending on the complexity of the request.
In some cases, prior authorization may be required for prescription medications, especially those that are new or have a high cost.
Blue Cross Blue Shield Texas will review your request and make a decision within the timeframe specified in your policy.
If your request is approved, you'll receive a notification from Blue Cross Blue Shield Texas, and you can proceed with the treatment or service.
If your request is denied, you'll receive a notification explaining the reason for the denial and any available appeal options.
Recommended read: Blue Cross Blue Shield of Texas Medicare Supplement
Frequently Asked Questions
What is the phone number for BCBS Texas prior authorization?
For BCBS Texas prior authorization, call 800-528-7264 or the phone number on the back of your ID card. This number can also be used for clinical review and referrals.
Does Blue Cross Blue Shield of Texas require a referral to see a specialist?
To see a specialist, Blue Cross Blue Shield of Texas typically requires a referral from your Primary Care Physician (PCP) for most services, except for your PCP. Check your plan details for specific requirements.
How do I submit a prior authorization to BCBSTX?
To submit a prior authorization to BCBSTX, call eviCore at 1-855-252-1117 or use their online Web Portal available 24/7. You can also refer to the eviCore implementation site for more information on the prior authorization process.
Who is responsible for getting pre-authorization?
If you're in-network, your healthcare provider handles prior authorization. If you're out-of-network, you're responsible for obtaining pre-authorization.
What is eviCore authorization?
EviCore authorization is a process that determines if a healthcare service or supply is medically necessary and covered under a member's benefits. It's an evidence-based decision that helps ensure members receive approved care
Sources
- http://www.bcbstxcommunications.com/newsletters/br/2020/march/web/nlt_br_providers_march_2020_new_prior_authorization.html
- https://publicsitestx.hcsc.net/provider/forms/
- https://www.ers.texas.gov/news/prior-authorization-and-referral-requirements-for-healthselect-of-texas-medical-plans
- http://www.bcbstxcommunications.com/newsletters/br/2020/february/web/nlt_br_providers_february_2020_new_prior_authorization.html
- https://texashealthagents.com/individual-health-insurance/bluecross-blueshield-of-texas/
Featured Images: pexels.com
