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

February 2020

New Prior Authorization & Referral Submission Tool via Availity® Provider Portal

The big picture: Blue Cross and Blue Shield of Texas (BCBSTX) is introducing a new online prior authorization and referral tool called Authorizations & Referrals (HIPAA-standard 278 transaction). The tool will soon be accessible through the Availity Portal. Watch for announcements in this newsletter and in News and Updates on the provider website.

The Authorizations & Referrals tool will have improved functionality, making submitting and receiving confirmation from BCBSTX* faster and easier. It will also allow providers to:

  • Access and verify the status of requests
  • Upload clinical medical records
  • Edit and/or extend requests
  • Obtain printable confirmation number for your records

During the transition period, you should migrate from iExchange® to the Authorizations & Referrals tool. Providers not yet registered with Availity can sign up today at Availity.comLeaving Site Icon, at no charge. For registration assistance call Availity Client Services at 1-800-282-4548.

Submitting online prior authorization requests using this new tool is easy and consists of only five steps:

  1. Log in to AvailityLeaving Site Icon.
  2. Select the Patient Registration menu option, choose Authorizations & Referrals, then Authorizations**.
  3. Select Payer BCBSTX, then choose your organization.
  4. Select Inpatient Authorization or Outpatient Authorization.
  5. Review and submit your authorization.

Deeper Dive

  • BCBSTX’s current electronic prior authorization tool, iExchange, will be deactivated April 15, 2020.
  • As of April 15, all electronic prior authorization requests and referrals should be submitted using the new tool. This includes:
    • Inpatient admissions
    • Select outpatient services
    • Behavioral health services
    • Referral requests handled by BCBSTX
  • Medical and surgical predetermination of benefits requests should be submitted via fax or mail by using the Predetermination Request FormAdobe Acrobat Icon, along with the pertinent medical documentation.

Note: The process of submitting prior authorization requests to eviCore® is not changing.

For More Information
Check soon for Availity Authorizations & Referral tip sheets, added to the Provider Tools section of our website. If you need further assistance or customized training, contact our Provider Education Consultants.

*For Federal Employee Program® (FEP®) members, providers should continue to use their current prior authorization process until this new application becomes available for FEP.

**Choose Referrals instead of Authorizations if you are submitting a referral request.

iExchange is a trademark of Medecision, Inc., a separate company that provides collaborative health care management solutions for payers and providers.

eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSTX. eviCore is wholly responsible for its own products and services.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore and Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.