Here is a heads up on a couple of changes in Blue Cross and Blue Shield of Texas’ (BCBSTX) preauthorization and predetermination processes.
Preauthorization through eviCore: Beginning Sept. 15, specialty benefits manager eviCore healthcare will respond by email to BCBSTX preauthorization requests you initiate through the eviCore web portal. The HIPAA-compliant email will tell you whether a determination has been made on a specific case, or if a case is still in process, with instructions to log in to eviCore for details.
If you initiate an eviCore request via phone or fax, you’ll continue to receive faxed responses. You’ll also have the option to request a faxed response when you initiate the request through the eviCore portal. If your email rejects a response from eviCore for any reason, eviCore will fax it to you. Patients will continue to get letters by mail in all cases.
Predetermination by fax: BCBSTX has updated its Preauthorization Request Form — Medical and Surgical, available on its Health Care Provider Forms page. Use this form if you prefer to fax requests rather than submit them electronically through the BCBSTX iExchange portal.
You can use the new form now, and you must use it as of Oct. 1 to prevent a rejected claim. The new form has the code 729617.0318 on the bottom.
Changes include fields for drug name, dose/frequency/duration, and procedure code/units. If you submit a predetermination request via iExchange, BCBSTX asks that you record this drug information in the Additional Notes section of the iExchange predetermination form.
Source: Blue Review, July 6, 2018
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