Blue Cross Blue Shield of Texas Prior Authorization

Blue Cross Blue Shield of Texas publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.

At a glance

BCBSTX says the provider is responsible for requesting prior authorization before performing a service for in-network care; most out-of-network services require utilization management review, and lack of prior authorization can lead to denial or post-service medical necessity review. Prior authorization may be handled by BCBSTX medical management or delegated vendors such as Alacura, eviCore, Carelon, or Magellan depending on the service and line of business.
Prior authorization rules vary by line of business and service category.
Emergency services are an exception to the out-of-network prior authorization expectation.
Prior authorization is not a guarantee of benefits or payment.

Where to verify prior authorization requirements

How to submit prior authorization requests

Availity Authorizations & Referrals for BCBSTX-managed services
Phone submission to the number on the member ID card for some services
Vendor portals or processes for delegated services (Carelon, eviCore, Magellan, Alacura)
Paper/fax for some behavioral health or other service-specific workflows
Submission resource 1
Submission resource 2
Submission resource 3

Information commonly required

Member information
Ordering or servicing provider information
Service or drug requested
Clinical documentation supporting medical necessity when required
Identification of whether the service is BCBSTX-managed or delegated to a vendor

Turnaround notes and caveats

BCBSTX states it responds to prior authorization requests, but the specific turnaround time depends on the program, vendor, and service; the cited pages do not provide one universal standard for all lines of business.
Medicare-specific prior authorization response time changes were announced for Medicare members, but the page does not establish a universal turnaround standard for all BCBSTX business.
Prior authorization rules vary by line of business and service category.
Emergency services are an exception to the out-of-network prior authorization expectation.
Prior authorization is not a guarantee of benefits or payment.

Provider resources

Provider home (official)
Contact Us / provider contacts (official)
Claims and eligibility - claim status (official)
Claims and eligibility - claim review process (official)
Utilization Management / prior authorization (official)
Availity Essentials / electronic transactions (official)
Blue Choice PPO Provider Manual - general claims filing (official)
Blue Choice PPO Provider Manual - electronic filing (official)
Medicaid claims page (official)
Medicaid/CHIP provider manual (official)

Sources

Fact	Value	Source	Confidence
Provider responsible for requesting PA for in-network care	The provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider.	Official	high
Out-of-network services usually require UM review	Most out-of-network services require utilization management review; if no authorization is obtained, the claim may be denied or subject to post-service medical necessity review.	Official	high
Delegated prior authorization vendors	BCBSTX prior authorization may be required via BCBSTX medical management, Alacura Medical Transportation Management, eviCore healthcare, Carelon Medical Benefits Management or Magellan Healthcare.	Official	high
BCBSTX-managed submissions via Availity	Submit prior authorization and referrals for BCBSTX managed services via Availity Authorizations & Referrals.	Official	high

Last reviewed: March 27, 2026

Sources used: 2 official