In support of House Bill 3459 and our participating providers, CHRISTUS Health Plan is pleased to announce that effective July 1, 2022, the prior authorization requirements have been updated for Texas and Louisiana Health Exchange, Texas and New Mexico Medicare Advantage, Commercial and Uniformed Services Family Health Plan.
The following types of services require Prior Authorization:
o All listed services on the NCHD Prior Authorization list
o All ABA Providers (All Services for Autism)
ALL LINES OF BUSINESS:
o All Out-Of-Network (OON) Services and Providers, including those who are contracted but not been fully credentialed
Note: If the requirements for prior authorization are not followed, CHRISTUS Health Plan may not pay for the services. In most cases, physicians and other providers will be responsible for getting the prior authorization from the health plan. We have instructions and procedures in place for providers to request prior authorization.
The clinical department will evaluate the request to assess the Medical Necessity and coverage of proposed treatment. CHRISTUS Health Plan will also check that the treatment is being provided at the appropriate level of care. Prior authorizations are approved or denied based on current evidence- based clinical standards of care and guidelines and not on incentives or bonus structures. The member and provider will receive notification of CHRISTUS Health Plan’s decision, whether approved or denied.
The following types of services require provider notification via the Notification form (below):
- Transplant Services
- Hemo Dialysis Services
The Prior Authorization lists for each specific line of business is below have been updated (below) to reflect these changes. Please remove any previous versions of the Prior Authorization list from your reference materials.
*PRIOR AUTHORIZATION DOES NOT GUARANTEE PAYMENT ON NON-COVERED BENEFIT.
**PRIOR AUTHORIZATION DOES NOT GUARANTEE COVERAGE OR ELIGIBILITY.
If you have any questions about the CHRISTUS Health Plan Prior Authorization list(s), please contact Member Services at 1-844-282-3100.
Hours of Operation:
- Health Insurance Exchange: 8 a.m. to 5 p.m., CST, Monday - Friday
- NCHD: 8 a.m. to 5 p.m., CST, Monday - Friday
Medicare Advantage: 8 a.m. to 8 p.m., CST, 7 days a week. (As of October 1 – March 31; and 8 a.m. to 8 p.m., CST, Monday - Friday)
USFHP: 8 a.m. to 5 p.m., CST, Monday - Friday
Prior Authorization Forms
Please complete prior authorization forms for your Individual and Family plan, Medicare Advantage plan, and US Family Health (USFH) plan.
Individual and Family Plan
Medicare Advantage Plan
US Family Health Plan (USFHP)
Prior Authorization Lists
CHRISTUS Health Plan has prior authorization requirements for some covered services. Please refer to the attached lists and contact Member Services by calling the following phone lines for any questions regarding the list.
For Individual and Family Plan (Texas and Louisiana) prior authorization inquiry, call:1-844-282-3025, 711 for TTY
For MA prior authorization inquiry, call:1-844-282-3026 TTY at 711
For US Family Health Plan prior authorization inquiry, call:1-800-678-7347 , 711 for TTY