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Coordinated Home Care & Home Infusion Therapy Prior Authorizations Reminders

October 29, 2021

To identify if a service requires prior authorization for our members, always check eligibility and benefits through Availity® Learn more about third-party links or our preferred vendor for services requiring prior authorization including those below:

Reminders:

  • As a provider rendering Coordinated Home Care (CHC) and Home Infusion Therapy (HIT), you can submit initial prior authorizations for both CHC and HIT requests via Availity Learn more about third-party links. Always submit the correct service type to avoid delays.
  • Referrals or prior authorizations for therapy services should be submitted separately.
  • You will get a real-time Availity or clinical review response per the prior authorization guidelines for initial requests by fax or phone directly to the provider.

What should you do?

  • Provide all pertinent information related to your patient services.
  • Specifically submit:
    • Referrals should only include consultation CPT codes. Note: referrals are for HMO plans only.
    • Prior authorizations with correct codes for CHC, HIT or therapy services
  • Call 1-800-441-9188 for concurrent/extensions requesting additional units or days. ever submit concurrent/extensions via Availity to avoid delays. You will receive your responses for additional units or days for current/extensions from Blue Cross and Blue Shield of Texas via fax or a phone call directly to the provider per concurrent/extension guidelines.

If you have questions, please call the number on back of the member's ID card or 1-800-441-9188.