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Red to Case Management: Name of Person Submitting Referral: Phone Number: - - Reason for Case Management Referral Health Assessment Questionnaire Has not seen physician in the past year Transplant New Referral (please check one): Type: S P Catastrophic Conditions (ADULT AND PEDIATRIC) Catastrophic/complex diagnosis requiring coordination of care, connection to services, coordination of benefits Compounding psychosocial factors presenting actual or potential barriers to care Chronic condi.

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Observation does not require prior authorization. However, if patient converts from observation to inpatient, the admission may require prior authorization. For information on behavioral health, refer to Section I of this Provider Manual.

Have your doctor fax in completed forms at 1-877-243-6930.

Why does my health insurance company need a prior authorization? The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition. For example, some brand-name medications are very costly.

Referrals are required under the HealthSelect of Texas® plan. A referral is a written order from your primary care provider (PCP) for you to see a specialist. For most services, you need to get a referral before you can get medical care from anyone except your PCP.

Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations* Select Payer BCBSTX, then choose your organization. Select a Request Type and start request. Review and submit your request.

Other Important Contacts. Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc.

If you have questions, please call Service Coordination toll-free at 1-877-301-4394.

Prior authorization (PA) may be required via BCBSTX's medical management, eviCore® healthcare, Carelon Medical Benefits Management effective March 1, 2023 (formerly AIM) or Magellan Healthcare®. You can review how to submit PA or Notification requests and view PA statistical data here.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232