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Beginning Sept. 1, 2024, prior authorization will be referred to as recommended clinical review.
Recommended clinical review involves a review of the proposed treatment and pertinent clinical information by the Blue Cross and Blue Shield of Texas clinical staff. During this review, the experts reviewing your provider’s request determine if the recommended treatment is right for your health needs.
It’s recommended that reviews are done before you get care. You’ll know early if the treatment is covered by TRS-ActiveCare. Approval depends on information your provider sends to BCBSTX medical staff.
When your provider requests care or service, it’s often important to have a clinical person who understands every aspect of your coverage review the request. They may know of another treatment option that’s just as effective and covered under your plan. Making sure your treatment is covered will save you money.
Elective inpatient medical and surgical facility admissions, including transfers:
Elective behavioral health and chemical dependency facility admissions:
Outpatient medical and surgical services:
Mental health and substance use disorder outpatient services:
Specialty pharmacy medications that are covered by medical benefits: