August 2018

New Private Duty Nursing Checklists and Pharmacy Prior Authorization Forms

Review the updates to Blue Cross and Blue Shield of Texas’ (BCBSTX) Long-term Services and Supports (LTSS) checklists and pharmacy prior authorization forms below.

LTSS Requests for Private Duty Nursing
Updates to the LTSS Authorization Request checklist and Recertification/Revision checklist for private duty nursing can be found on the BCBSTX Utilization Management web page. Questions on these updated forms can be directed to 1-877-301-4394.

Pharmacy Prior Authorization Forms
Also review the newly added prior authorization forms for STAR/CHIP and STAR Kids listed below. Access the new forms via the links:

STAR/CHIP Prior Authorization Forms

• Dispensing Limit Override
• Opioids, Extended Release (ER) Quantity Limit
• Oxycodone ER
• Propylthiouracil
• Provigil Nuvigil

STAR Kids Prior Authorization Forms

• Dispensing Limit Override
• Provigil Nuvigil

Please call 1-855-457-0407 with any questions you have about the pharmacy prior authorization forms. The standard Texas Department of Insurance Prior Authorization forms can also be used; however, the BCBSTX forms list all required information and you may find them easier to use.