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Medicare Clinical Guidelines 

Blue Cross and Blue Shield of Texas uses Medicare and internal medical policies to make sure you get the health care you need. Our clinical team uses evidence-based clinical guidelines to make sure you can get safe and necessary care. Policies are based on scientific and medical research. There are no rewards to deny or promote care.

Always talk to your doctor about any health questions or concerns. You can also check with your doctor if you have questions about prior authorization or medical policies.

Use the links below to review BCBSTX and vendor guidelines that may apply.

  • BCBSTX Medical Policies
  • EviCore – On this Clinical Guidelines web page, choose the category that best fits your needs.
    • Choose “I Accept” in the pop-up to allow access to the information.
    • In the search bar, type the name of your plan. To find information based on your BCBSTX plan, use this format: BCBS TX
    • If there is information for your plan in the category you chose, you will find it there.
  • Blue Access for Members
    • Log in to BAM to access the MCG Care Guidelines website.

If you want to know more about the utilization management process or how decisions are made about your care, Contact Us.