Until 2020, telehealth represented one half of 1 percent of all BCBSTX members' behavioral health appointments. Legal and Privacy This plan type helps pay for prescription drugs. RICHARDSON, Texas, June 7, 2023 /PRNewswire/ -- Following a Blue Cross and Blue Shield of Texas(BCBSTX)network expansion in January, BCBSTX members now have access to nearly 4,000 in-network behavioral health providers through Headwayand are able to receive care 2-3x faster than average. If you just need coverage at the pharmacy and already have a medical plan, these plans are a good fit. All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan The Behavioral Health program is available only to those members whose health plans include behavioral health benefits through BCBSTX. Refer to the Medical Necessity Criteria & Prior Authorization for Behavioral Health Services page for details on when and how to submit prior authorization requests. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Its important to use the Availity Provider Portal or your preferred vendor to check eligibility and benefits for all members before rendering services. Home During each episode of authorized treatment, the BH Outpatient Management team may outreach to the provider to participate in the concurrent review process. All Rights Reserved. Learn more, Behavioral Health providers have contractually agreed to offer appointments to our members according to specific appointment access standards. This link will take you to a new site not affiliated with BCBSTX. Copyright 2018 Health Care Service Corporation. Instead, these plans cover the costs you're responsible for with Original Medicare. If the provider does not submit the requested information within the 30-day timeframe, BCBSTX may not be able to determine if the care and treatment provided is medically necessary or appropriate. This program is a claims-based approach to touch all routine cases through clinical logic. A network with over 80,000 doctors in Michigan and more than 1.7 million doctors nationwide. To return to our Web site, simply close the new window. The provider will be asked to complete an enclosed Clinical Update Request Form and return it to BCBSTX within 30 days of the date of the letter. To return to our website, simply close the new window. All Rights Reserved. To return to our website, simply close the new window. You pay 20 percent coinsurance for most services with Original Medicare. Blue Cross and Blue Shield of Texas (BCBSTX) provides complimentary training opportunities for providers, billing services, clinical and administrative staff members who are new or already participating in the BCBSTX network. Coordinating Care Between Behavioral Health and Medical Providers Blue Cross Blue Shield of Texas is committed to giving health care providers with the support and assistance they need. This structure allows the BH team to follow/monitor members as they step down from intensive levels of care (inpatient, residential, partial hospitalization) to less intensive levels (intensive outpatient, routine outpatient), ensuring that they have access to the most appropriate and effective treatment. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, Contact Magellan Health Services or call 1-800-788-4005, For prior authorization, benefits, eligibility, or claims status or questions contact Magellan at 1-800-327-7390, Magellans Primary Care Physician (PCP) Toolkit. Behavioral health claims must be submitted to BCBSTX for reimbursement. All behavioral health benefits are subject to the terms and conditions as listed in the members benefit plan The Behavioral Health program is available only to those members whose health plans include behavioral health benefits through BCBSTX. Medicare supplement plans don't work like most health insurance plans. We provide health insurance in Michigan. If you have any questions, call the number on the members ID card. Some members may not have outpatient behavioral health management. This will help you confirm coverage details and other important information, including prior authorization requirements. The BCBSTX Behavioral Health Program encompasses a portfolio of resources that help BCBSTX members access benefits for behavioral health (mental health and substance use disorder) conditions as part of an overall care management program. Legal and Privacy The benefit of the full Program BH Program inpatient and outpatient management is that it allows the BH team to assist members throughout the entire continuum of their BH care and treatment. Access and download these helpful BCBSTX health care provider forms. Blue Cross and Blue Shield of Texas (BCBSTX) the only statewide, customer-owned health insurer inTexas is the largest provider of health benefits in the state, working with more than 140,000 physicians and health care practitioners, and 520 hospitals to serve more than 7 million members in all 254 counties. 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