Clinical Resources

Behavioral Health Care Management Program

Learn more about the Behavioral Health Care Management Program.


Clinical Practice Guidelines

Learn more about clinical practice guidelines.


eCards for Health

Learn more about eCards for health.


eviCore Preauthorization Program

Learn more about the eviCore Preauthorization program.


iExchange® — Automated Preauthorization and Referral System

Learn more about iExchange, the automated preauthorization and referral system.

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.


Preauthorizations/Notifications/Referral Requirements

Review the Preauthorizations/Notifications/Referral Requirements


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.

HEDIS® BMI Assessment Tip Sheet


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.


Wellness Initiatives/Programs

Wellness initiatives/programs


Preventive Care Guidelines/Patient Wellness Guidelines

Learn more about Preventive Care Guidelines/Patient Wellness Guidelines