ERS Tools

BCBSTX is the third-party administrator for the ERS HealthSelect of Texas® and Consumer Directed HealthSelectSM (HealthSelect) benefit plans that access care through a custom point-of-service network using Blue EssentialsSM providers in all 254 counties in Texas.

ERS Participant Plans

HealthSelect of Texas (In Texas)

  • Participants must select a primary care provider (PCP) participating in the Blue Essentials provider network.
  • Referrals are required to see Blue Essential providers for in-network benefits.

Important: Participants are required to obtain a referral from their PCP prior to seeing a specialist for most services even if the specialist received medical necessity approval by completing a voluntary or recommended clinical review for services 09/01/2024 and after or a prior authorization prior to 09/01/2024.

  • Referrals are not required for the following:

    • Covered vision care, including routine and diagnostic eye exams
    • OB/GYN visits
    • Mental health counseling
    • Chiropractic visits
    • Occupational therapy and physical therapy
    • Virtual visits through MDLIVE and Doctor on Demand, urgent care centers and convenience care clinics.

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.

Consumer Directed HealthSelect (In Texas)

  • Participants have open access to providers in the Blue Essentials provider network for in-network benefits.
  • PCP selection or referrals are not required when accessing Blue Essentials providers for in-network benefits.

HealthSelect of Texas and Consumer Directed HealthSelect Out-of-State

  • ERS participants living outside of Texas have access to a PPO network under Blue Card.

HealthSelect Secondary 65+

  • ERS Retirees and Participants are eligible for Medicare.
  • ERS participants with Medicare (primary or secondary) have access to the BCBSTX Traditional/Par network.
  • This plan does not require PCP selection and does not require referrals.

Prior Authorization

Refer to the ERS Prior Authorization page for services requiring PA prior to 9/1/2024. Effective 09/01/2024, participants no longer have any services that require prior authorization. Refer to Recommended Clinical Review below effective 9/1/2024.

Recommended Clinical Review

Effective Sept. 1, 2024, providers may request a recommended clinical review for a pre-service medical necessity review (including services previously requiring prior authorization). RCR prevents medical necessity reviews post service for the requested procedure codes or services.

RCR will inform you of situations where a service may not be covered based upon medical necessity or other plan rules.

Refer to the RCR page under Utilization Management for a list of services applicable for recommended clinical review for ERS participants The list will indicate who to contact for the RCR request (BCBSTX, Carelon or ProgenyHealth).

Providers submitting RCR requests for services managed by BCBSTX for ERS participants will have the option of submitting the request electronically via Availity® Authorization & Referrals tool or effective Sept. 3, 2024, via BlueApprovRSM

Note: Providers may continue to request medical necessity review of additional services even when not included on the RCR Services List.

How to Identify ERS Participants

  • The plan names HealthSelect of Texas and Consumer Directed HealthSelect will be printed directly on the ID card.
  • Some ERS participants in Texas will have a unique network ID labeled HME.

How to be an In-Network Provider for ERS Participants

  • Must have privileges at one of the Blue Essentials/HealthSelect participating hospitals (unless inpatient admissions are uncommon or not required for the provider's specialty or provider has someone who will admit on their behalf)
  • Must have a valid National Provider Identifier (NPI) number
  • Must sign a Blue Essentials agreement

If you are interested in participating, please visit the Network Participation – How to Join page and follow the steps.

Mental Health Services

 BCBSTX manages mental health benefits and services for HealthSelect plans, including network management

Telemedicine and Virtual Visits

HealthSelect participants have benefits for telemedicine/telehealth and virtual visits.

  • Virtual Visits

Medical and mental health virtual visits are available through Doctor on Demand and MDLIVE. Use the Availity® Essentials or your preferred vendor to check eligibility and benefits.

  • Telemedicine/Telehealth

Use the Availity Essentials  or your preferred vendor to check eligibility and benefits. You can also refer to Section 5, Schedule of Benefits and Coverage, in the plan’s Master Plan Benefits Documents for more information.

  • Submitting Telemedicine/Telehealth and Virtual Visit Claims

For details on submitting telemedicine/telehealth claims, refer to our Telemedicine and Telehealth Services page.

Outpatient Clinical Laboratory Information

Effective 01/01/2022, all Plan providers should refer members to in-network lab providers for outpatient lab services. To locate participating labs in the Plan network, visit Provider Finder® on the BCBSTX website.

Statewide In-Network Clinical Labs for HealthSelect Participants include:.

Effective through 12/31/2021, providers located in the Reimbursable Lab County List can perform labs on the Reimbursable Lab List in the provider's office for HealthSelect of Texas and Consumer Directed HealthSelect of Texas participants. All other lab services must be sent to a participating lab.

Refer to Provider Finder for additional participating clinical laboratory providers.

Helpful Information

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.