2025 Prior Authorization Exemption Renewal Results Now Available
AI Summary
Blue Cross Blue Shield of Texas has completed their annual review of prior authorization exemptions for 2025. Some providers may have had their exemptions rescinded if less than 90% of their claims were deemed medically necessary, requiring them to resume submitting prior authorization requests for affected services.
Action Required
Immediately: Check Provider Correspondence Viewer in Availity Essentials for Blue Cross and Blue Shield of Texas to see if any prior authorization exemptions were rescinded. If exemptions were rescinded, update billing workflows to require prior authorization submissions for those specific services starting on the rescission effective date listed in your notice. Staff must resume using Availity Authorizations & Referrals or calling member ID card numbers for prior auth requests.
Plan Types
Commercial
States
TX
Specialties
all-specialties