We’ve Reviewed Prior Authorization Exemptions for May 1, 2025, Through April 30, 2026
July 1, 2026
We’ve reviewed providers for new or previously rescinded prior authorization exemptions effective July 1, 2026. To view the notices, refer to the Provider Correspondence Viewer in Availity® Essentials’ payer spaces for Blue Cross and Blue Shield of Texas. If you requested alternate methods for your prior authorization exemption communications, the results will be communicated through those channels.
Pharmacy exemptions: Prior authorization exemption status for any prior authorization managed by a pharmacy benefit manager is handled and conveyed by the PBM.
Notification acknowledgements: If you have qualified for an exemption, submit a notification to BCBSTX to determine the initial length of stay or initial units exempted for services. Services rendered beyond the initial length of stay or units covered by the exemption may be reviewed for medical necessity.
Submit notifications through Availity Essentials or by calling the number on the member’s ID card. You’ll receive a notification acknowledgement for the specific services allowable per the prior authorization exemption. Concurrent review is still required for ongoing or extension of services beyond care guidelines.
If you qualified to be reviewed and your prior authorization exemption was denied, you may request a review by an independent review organization not associated with BCBSTX via fax at 972-907-1868 or by email. The request must be received within 30 days of the date on the notice.
The Texas Department of Insurance will assign the IRO provider, which will make a decision within 30 days of receipt of the request. For information about the independent review process, please contact TDI at 866-554-4926, option 2 or by email.
See our prior authorization exemptions and utilization management pages for more information.
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