Alacura

Alacura is a medical transport management company who manages air and ground medical transportation, utilization, prior authorization, recommended clinical review and retrospective claim reviews for fully insured members and certain Administrative Services Only groups* effective Jan. 1, 2025. 

Alacura manages:

  • Air (Interfacility transfer for both fixed wing and rotor flights)
  • Ground (reviewing level of care from basic life support to advance life support and urgency level for emergency and non-emergency transportation)
  • Easy workflows and simple administrative processes to help with locating available ambulances, beds at the receiving hospital and other logistics of your patient’s transport
  • Assurance that members are transported by an in-network provider where possible while proving cost effectiveness of member benefits.

*Alacura does not manage:

  • BCBSTX Medicare Advantage and BCBSTX Medicaid
  • 911/scene of accident or residence-based pickups

Prior Authorization and Recommended Clinical Review

For more information and a full list of codes refer to the Prior Authorization Services for Fully Insured members and certain Administrative Services Only groups and the Recommended Clinical Review Options as follows:

  • Prior Authorization Services List for Other ASO Groups Effective 01/01/2024
  • Prior Authorization Procedure Codes List for Other ASO Plans Effective 01/01/2025
  • 2024 Recommended Clinical Review, Post Service Review and Non-Covered Procedure Code List for Fully Insured Accounts (Includes Services Effective 01/01/2025) 

Submitting Requests to Alacura

Facilities and providers need to contact Alacura immediately once the transport decision is made. Ambulance providers will want to check that Alacura has been engaged for patient facility transports before picking up the patient to ensure transport will be approved. Nurses are available 24/7/365 for real-time verbal assessments.

How do I contact Alacura?

Check Eligibility and Benefits
Providers should check eligibility and benefits through Availity® Essentials or their preferred vendor. This may also indicate if a service requires a prior authorization, recommended clinical review. or retrospective review.

REMINDERS:

  • Ensure you have all the following before requesting a Prior Authorization or RCR from Alacura:
    • Your name, call back #, what unit are you calling from
    • Sending hospital name, receiving hospital name
    • Patient name, DOB, member ID
    • When are you wanting to transfer
    • DX of patient, overall condition, and reason for transfer
  • For BlueCard® members, please contact Customer Service utilizing the phone number on the back of the ID card to determine if the Alacura prior authorization applies.

 

Alacura Medical Transportation Management, LLC. is an independent company that has contracted with Blue Cross and Blue Shield of Texas to provide utilization management services for members with coverage through BCBSTX.

Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan.

Please note that checking of eligibility and benefits information, and/or the fact that any pre-service review has been conducted, is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. 

BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.