October 2018

BCBSTX Pre-authorization and Notification Changes Beginning Jan. 1, 2019

Effective Jan. 1, 2019, benefit plans managed by Blue Cross and Blue Shield of Texas (BCBSTX) will be updating preauthorization and prenotification requirements.

Patient eligibility and benefits should be verified prior to every scheduled appointment. Eligibility and benefit information includes membership verification, coverage status and, preauthorization requirements. To obtain fast, efficient and detailed information for BCBSTX members, please access the Availity^® Eligibility and Benefits tool located on Availity.com. Please note that you must be registered with Availity to gain access to this free online tool. Additional tip sheets are available on the BCBSTX provider website under Claims and Eligibility.

Watch for future updates to the Pre-authorizations/Notifications/Referral Requirements lists reflecting the 2019 changes. These will be posted on the BCBSTX provider website under the Clinical Resources page.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. Aerial, iExchange and Medecision^® are trademarks 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 Availity or Medecision. The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.

Please note that verification of eligibility and benefits, and/or the fact that a service or treatment has been preauthorized or predetermined for benefits, is not a guarantee of payment. Benefit determination will occur when a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services when rendered.