CHRISTUS Health Plan Prior Authorization

CHRISTUS Health Plan prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

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