CHRISTUS Health Plan Prior Authorization

CHRISTUS Health Plan 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

• Prior authorization is required for some services, and CHRISTUS states that failure to follow prior authorization requirements may result in non-payment. The official page provides separate prior authorization lists/forms by line of business and turnaround times that vary by product. For Texas Individual & Family, providers are instructed to use the Texas Standard Prior Authorization Form and submit requests by fax. For NCHD, the same Texas Standard form/fax instruction applies. USFHP, Medicare Advantage, and Louisiana Exchange have their own forms/lists. For out-of-network services, a separate OON prior authorization process applies to Health Insurance Exchange and USFHP.
• Prior authorization does not guarantee payment for non-covered benefits or guarantee coverage/eligibility.
• The prior authorization lists were noted as being updated in progress; users are told to check the page for the most current information.
• The official page says physicians/providers are usually responsible for obtaining prior authorization.
• Out-of-network prior authorization process is explicitly described only for Health Insurance Exchange and USFHP on the cited policy.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• Fax (Texas Individual & Family Health Exchange prior authorization requests)

• Provider portal / online provider resources (general portal access to prior authorization tools)

• Line-of-business-specific prior authorization forms and lists

• Submission resource 1

Information commonly required

• Member/provider receive notification after UM review of medical necessity and level of care
• Line of business / product-specific prior authorization form
• Clinical/medical necessity information supporting the request
• Use the applicable prior authorization list for the member's line of business
• For out-of-network requests, information showing service is unavailable in network, member is traveling, or travel time exceeds limits

Turnaround notes and caveats

• LA HIX: Urgent/Expedited 2 business days; Concurrent 48 hours; Routine 5 business days
• TX HIX: Urgent/Expedited 1 business day; Concurrent 1 business day; Routine 2 business days
• USFHP: Urgent/Expedited 1 business day; ER admission 1 business day; elective admission 3 business days; 90% <= 2 business days; 100% <= 5 business days
• Medicare Advantage: 72 hours urgent/expedited; 72 hours concurrent; 7 calendar days routine
• Turnaround times are stated to be subject to change based on regulatory requirements and UM guideline updates
• Prior authorization does not guarantee payment for non-covered benefits or guarantee coverage/eligibility.
• The prior authorization lists were noted as being updated in progress; users are told to check the page for the most current information.
• The official page says physicians/providers are usually responsible for obtaining prior authorization.
• Out-of-network prior authorization process is explicitly described only for Health Insurance Exchange and USFHP on the cited policy.

Provider resources

• Provider Resources (official)
• Provider Portal (official)
• Prior Authorization Forms and Lists (official)
• Quick Reference Guides and Manuals (official)
• Provider Forms (official)
• Policies and Procedures (official)
• Provider Relations Team (official)

Sources