Basic Coverage*: Full-Time Employees *Basic Coverage includes UT SELECT (medical and prescription coverage), plus the cost of employee $50,000 Basic Life and employee $50,000 Basic Accidental Death and Dismemberment. Summary of Benefits and Coverage UT offers one medical insurance plan, UT SELECT, a self-funded PPO plan, administered by Blue Cross and Blue Shield of Texas. If you use a
network doctor, you will receive the highest level of benefits, pay much less out-of-pocket, and will usually not have to file any claims. If you use an out-of-network doctor, you will still be covered, but your out-of-pocket costs for health care services will be substantially higher. General Inquiries1-972-766-6900 Blue Cross and Blue Shield of Texas FEP Service Claims/Customer ServiceBlue Cross and Blue Shield of Texas PrecertificationDisease/Care Management ProgramsAsthma Chronic Obstructive Pulmonary Disease If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. The “Prior authorization list” is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to payment authorization. Members and providers are encouraged to obtain prior authorization and may call Customer Service to inquire about the need for prior authorization. While the list below covers the medical services, drugs, and procedures that require authorization prior to rendering; Blue Shield may require additional information after the service is provided. If further information is required to process the payment Blue Shield’s Claims department will reach out and will request the specific information at that time. Before providing service please contact Customer Service or access the provider connection website to verify the service is a covered benefit. Blue Shield of California providersPrior authorization for the services listed below is highly recommended. For more information on obtaining prior authorization review refer to your provider manual. If authorization was not obtained prior to the service being rendered, the service will likely be reviewed for medical necessity at the point of claim. Please include medical records when you are ready to submit for claim payment, review our medical policies, and verify the service is a covered benefit online through our provider connection website or contact Customer Service. If prior authorization was obtained and you are submitting an offline (i.e. paper) claim, remember to attach a copy of the prior authorization letter. Prior authorization requirements for out-of-area Blue Plan membersProviders can view medical policy and general prior authorization requirements for patients who are covered by an out-of-area Blue Plan, using our Medical policy and general prior authorization requirements for out-of-area members tool. Blue Shield of California Promise Health Plan providersSee the list of the designated medical and surgical services and select prescription drugs, which require prior authorization under a Blue Shield of California Promise Health Plan medical benefit. Advanced imaging servicesPrior authorization medical necessity reviews are highly recommended for certain non-emergency outpatient advanced imaging procedures (CT, MRI, MRA, PET, cardiac nuclear medicine) for Administrative Services Only (ASO), HMO Direct Contracting and PPO plans. Review requests for services are performed by National Imaging Associates. Visit the NIA website to use this service, or call (888) NIA-BLUE (642-2583). Spine surgery and pain management servicesPrior authorization medical necessity reviews are highly recommended for certain spinal procedures (spinal surgery, spinal injections, spinal implants) for Administrative Services Only (ASO), HMO Direct Contracting, and PPO plans. Review requests for services are performed by National Imaging Associates. Visit the NIA website to use this service, or call (888) NIA-BLUE (642-2583). Federal Employee ProgramMembers of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. Out-of-area providersIf you are an Out-of-area provider treating a Blue Shield of California member, contact the customer service phone number on the back of the member’s card to verify if the service is a covered benefit under the plan and to verify if prior authorization is required. Prior authorization list (Medical)The document below lists prior authorization codes for Blue Shield (including Medicare 65+). View Blue Shield Prior Authorization list (PDF, 107 KB) Prior authorization information for medicationsPrior Authorization information for medications can be found here for the following plans: Medicare Plans [Part D drug list, Part B PPO], Medical Benefit Commercial Plan, Medical Benefit PHP Medi-Cal Plan, and Pharmacy Benefit Commercial Plan Does BCBS of Texas require prior authorization?Prior authorization (PA) may be required via BCBSTX's medical management, eviCore® healthcare, AIM specialty Health® or Magellan Healthcare®. You can review how to submit PA or Notification requests and view PA statistical data here.
How do I get preIn order to obtain pre-authorization, front office staff must submit the correct CPT code to the insurance company along with a request form and other supporting documentation. Within five to ten business days, the request will either be approved or denied.
Is prior authorization the same as utilization management?Prior authorization (PA) is a utilization management tool that enables plans to implement patient-focused goals of safe and appropriate medication use. Also known as coverage determinations in the Medicare Part D program, PA coverage criteria are centered on patients' clinical needs and therapeutic rationale.
What's the difference between prior authorization and predetermination?A predetermination is a courtesy, where a pre-authorization is a requirement under a plan.
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Blue cross blue shield of texas prior authorization list
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