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

March 2020

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

The big picture: As of Feb. 17, 2020, providers can submit prior authorizations and referrals online using Avality’s Authorizations & Referrals tool (HIPAA-standard 278 transaction). The tool is accessible through the Availity PortalLeaving Site Icon.

The Authorizations & Referrals tool has improved functionality, making submitting and receiving confirmation from Blue Cross and Blue Shield of Texas (BCBSTX)1 faster and easier.

The bottom line is that the tool will 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

Get Started!
Begin using the Authorizations & Referrals tool in place of iExchange®. 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.

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

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® or Magellan Healthcare® is not changing.

For More Information
Review Availity Authorizations & Referrals, added to the Provider Tools section of our website. If you need further assistance or customized training, contact our Provider Education Consultants.