Clinical Resources

Availity® Authorizations & Referrals

Authorizations & Referrals is an online tool in the Availity Provider Portal that allows you to submit prior authorization and/or referral requests handled by Blue Cross and Blue Shield of Texas (BCBSTX). Learn More.

Behavioral Health Care Management Program

Learn more about the Behavioral Health Care Management Program.

Clinical Practice Guidelines

Learn more about clinical practice guidelines.

eviCore Prior Authorization Program

Learn more about the eviCore Prior Authorization program.

iExchange® — Automated Prior Authorization and Referral System

Learn more about iExchange

Prior Authorizations & Predeterminations

Review information related to Prior Authorizations & Predeterminations

Pre-cert/Pre-auth Router (for out-of-area members)

Have the alpha prefix ready to find medical policy, pre-certification and pre-authorization information (for out-of-area members).

Quality Improvement

The Blue Cross and Blue Shield of Texas (BCBSTX) Quality Improvement Department strives to provide products and services of the highest quality and value with a direct focus on meeting the needs of the customer. The process for delivery of care and services is constantly changing offering ongoing opportunities for improvement.

We support our health care provider’s efforts to provide quality services and products and believe that through monitoring and evaluation, we can work together to benefit both members and health care providers. This resource applies to our commercial and retail products and was created as a reference for clinical quality improvement. To assist our providers, the Quality Improvement Department provides HEDIS® Tip Sheets located in the Related Resources section on the right-hand side of this page.

Radiology Quality Initiative Program

Learn more about the radiology quality initiative/program.

For additional information, refer to the Pre-Service Review for Out-of-Area Members tip sheet, located with other tip sheets under iExchange® on the Provider Tools page. You can also refer to the Electronic Provider Access (EPA) FAQs for additional information. For more information about iExchange, including how to register if you are not a current user or training opportunities, visit the Provider Tools page.

View the current procedural technology (CPT) codes affected by this program.

Special Beginnings — A Maternity Program

Learn more about our Special Beginnings maternity program — a healthy start for mothers and babies.

Preventive Care Guidelines/Patient Wellness Guidelines

Learn more about Preventive Care Guidelines/Patient Wellness Guidelines