The services on the lists below may require prior authorization or a recommended clinical review may be applicable by Medical Management at BCBSTX or Carelon Medical Benefits Manragement for ERS participants.
- The presence of codes on these lists does not necessarily indicate coverage under the member/participant’s benefits contract.
- Consult Availity® or your preferred vendor for eligibility and benefits, the member/participant benefit booklet or contact a customer service representative to determine coverage for a specific medical service or supply.
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Employees Retirement System of Texas (ERS) Prior Authorizations and Recommended Clinical Review
Important Notice
Recommended Clinical Review – Effective 09/01/2024
HealthSelect of Texas® and Consumer Directed HealthSelectSM participants will no longer have any services that require prior authorization effective Sept. 1, 2024. Providers are encouraged to request Recommended Clinical Review pre-service to prevent post-service medical necessity reviews, which may delay or deny processing of services.
The following services are applicable to RCR for ERS participants:
Important: Medical necessity does not guarantee payment. Eligibility and other plan requirements must be met. You can access the HealthSelect and Consumer Directed HealthSelect documents at: https://healthselect.bcbstx.com/medical-benefits.
Refer to the RCR page for more information.
Prior Authorization Information Prior to 09/01/2024:
- Prior Authorization Update Notice for HealthSelect Network Providers Effective Jan.1, 2023 - Aug. 31, 2024
- HealthSelect of Texas® Prior Authorization Waiver List as of 01/01/2023
- Medical Oncology Prior Authorizations Transitioned to Carelon Medical Benefits Management (Carelon) for Employees Retirement System of Texas (ERS) effective Sept. 1, 2022 - Aug. 31, 2024
ERS Consumer Directed HealthSelectSM In-Area (Texas)
Effective 09/01/2022 - 08/31/2024:
- ERS Consumer Directed HealthSelectSM (In Texas) Prior Authorization & Referral Requirements List 9/1/2022
- See also ERS Specialty Drug list below
Effective 9/1/2020 - 08/31/2022 - 08/31/2024:
ERS HealthSelect of Texas® In-Area (Texas)
Important: PCP designation and referrals are required for services to be processed at the in-network benefit level on this plan. If a referral is required, one must be on file with BCBSTX prior to obtaining a prior authorization. If a referral and a prior authorization are required, and the participant does not have one on file with BCBSTX before rendering services, the claims you submit may be processed at the lower out-of-network benefit level.
Effective 09/01/2022 - 08/31/2024
- ERS HealthSelect of Texas® (In-Texas) Prior Authorization & Referral Requirements List – 9/1/2022
- See also ERS Specialty Drug list below
Effective 9/1/2020 - 08/31/2022:
ERS HealthSelect of Texas® & Consumer Directed HealthSelectSM Out-Of-State
Effective 09/1/2022 - 08/31/2024
- ERS HealthSelect of Texas® & Consumer Directed HealthSelectSM Out-Of-State Prior Authorization & Referral Requirements List – 9/1/2022
- See also ERS Specialty Drug list below
Effective 9/1/2020 -08/31/2022 - 08/31/2024
ERS Specialty Drug List
Effective 9/1/2021 - 08/31/2024 (includes updates effective 09/01/2022):
Effective 9/1/2017 - 08/31/2021:
Related Links
- Availity® Authorization & Referrals
- Blue ApprovRSM - Effective 09/03/2024 for ERS participants
- Medical Policies
- Recommended Clinical Review