Blue cross blue shield of texas prior authorization phone number

Q: Does BCBS of Texas require prior authorization?

Prior authorization (PA) may be required via BCBSTXs 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.

The Pulse, May 2021

Table of Contents Show

TRS-ActiveCare and TRS-Care Standard
Connect with BCBSTX
Know What Your Plan Requires
Track Your Status
TRS-Care Medicare Advantage
Check Your Coverage
Work with Your Provider
Ask Questions When You Need to
Does BCBS of Texas require prior authorization?
Is BCBS the same as BCBS of Texas?
Is Anthem Blue Cross Blue Shield?
Can Blue Cross Blue Shield of Texas be used in any state?

Sometimes you might need what’s called prior authorization before you can get a medical procedure or service done. This simply means getting approval for it beforehand. With prior authorization, your health insurance agrees to pay for the service — and it’s important to know that ahead of time.

Most in-network providers will handle prior authorization for you. But it’s always a good idea to check with your doctor before your service to make sure it was approved. This will protect you from getting surprise out-of-pocket bills.

Here are some tips on how to handle prior authorization within your TRS health plan.

TRS-ActiveCare and TRS-Care Standard

Sometimes you may need to get approval from Blue Cross and Blue Shield of Texas (BCBSTX) before your TRS health plan will cover certain inpatient and outpatient services.

Connect with BCBSTX

If you haven’t already, sign-up for a Blue Access for MembersSM (BAMSM) account. Also, download the BCBSTX App, available in the Apple App Store and Google Play Store.

Both can help you conveniently keep up with your benefits anytime. You can even use the App to chat with a live Personal Health Guide.

Know What Your Plan Requires

Your plan requires prior authorization for some medical and behavioral health services such as:

acute care
certain outpatient behavioral health services
hospice
long-term acute care
rehabilitation
residential and Partial Hospital Programs (PHP)
skilled nursing facility care

For a complete list of prior authorizations, you can visit the TRS-ActiveCare or TRS-Care Standard website.

Track Your Status

You can check online to see whether your doctor submitted or BCBSTX approved your prior authorization. Log in to BAM and click on the My Coverage tab. Next, click on Referral and Prior Authorization Information. In the BCBSTX App, click More, then Prior Authorization.

You can also call a Personal Health Guide (PHG) at 1-866-355-5999, 24 hours a day, seven days a week, for any prior authorization questions.

Prior authorization typically takes seven to 14 business days. Your provider can request expedited prior authorization for approval in 24 to 72 hours.

If coverage for a service is denied or not approved by the time of your procedure, you may have to change your treatment plans. If your procedure is scheduled and you haven’t received approval, contact a PHG or doctor for assistance.

If you get the service without prior authorization, you’ll have to pay the entire cost. However, you have the right to appeal the decision. Find information about the appeal process on TRS’ website.

Still have questions? Call 1-866-355-5999 or use the chat feature of the BCBSTX App to connect with a Personal Health Guide. You can also watch BCBSTX’s Prior Authorization video.

TRS-Care Medicare Advantage

UnitedHealthcare is committed to helping make sure you receive care that is appropriate for you and your unique health care situation. One way they do this is by requiring a prior authorization for certain medical procedures and services.

Check Your Coverage

If you are unsure of whether you need prior authorization for a service, take a look at your coverage documents on www.UHCRetiree.com/TRS-CareMA or call the number on your TRS-Care member ID card.

Some procedures or services that may require prior authorization include:

all inpatient services and inpatient rehabilitation
mental health care
substance abuse care
sub-acute skilled care
private duty nursing
home health
hospice
high-tech radiology
rehabilitation care
home infusion
medical covered specialty drugs

Work with Your Provider

Prior authorization should be handled by your health care provider on your behalf and UnitedHealthcare.

Your provider submits the care recommendation for your treatment plan and then it’s reviewed by UnitedHealthcare. UnitedHealthcare will notify you by mail that your procedure or service has been approved, denied or if more information is needed. Be sure to read your prior authorization letter closely and provide any additional requested information in a timely manner.

Ask Questions When You Need to

If you have questions about prior authorization, contact UnitedHealthcare at 1-866-347-9507, TTY 711, 7 a.m.–6 p.m. CT, Monday–Friday.

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.

Is BCBS the same as BCBS of Texas?

BCBSTX is a Division of Health Care Service Corporation (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country's largest customer-owned health insurer and fourth largest health insurer overall.

Is Anthem Blue Cross Blue Shield?

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company an independent licensee of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.

Can Blue Cross Blue Shield of Texas be used in any state?

Most Blue Cross Blue Shield members can rest easy since Blue Cross Blue Shield coverage opens doors in all 50 states and is accepted by over 90 percent of doctors and specialists. And if your extended travel plans take you abroad, you can ensure you have access to quality care through GeoBlue.