Update: Behavioral Health Substance Use Criteria for Utilization Management
AI Summary
Blue Cross Blue Shield of Texas is updating their substance use disorder medical necessity reviews to use ASAM's fourth-edition criteria for adults effective July 1, 2025, while continuing to use third-edition criteria for adolescents. This changes their utilization management and prior authorization processes for behavioral health substance use services.
Action Required
By July 1, 2025: Providers treating adult substance use disorders must ensure documentation aligns with ASAM's fourth-edition criteria for prior authorization approvals and medical necessity reviews. Continue using third-edition criteria documentation for adolescent patients. Monitor Blue Review and BCBSTX News and Updates for additional program changes.
Plan Types
All Plans
States
TX
Specialties
psychiatry, family-medicine, internal-medicine, emergency-medicine