Prior Authorization
The Utilization Management (UM) 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.
- View clinical criteria used by CHRISTUS Health Plan
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.
Disclaimer:
*PRIOR AUTHORIZATION DOES NOT GUARANTEE PAYMENT ON NON-COVERED BENEFIT.
**PRIOR AUTHORIZATION DOES NOT GUARANTEE COVERAGE OR ELIGIBILITY.
The Prior Authorization lists for each specific line of business is below. Please remove any previous versions of the Prior Authorization list from your reference materials.
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.
- Individual and Family Plan: for a (Texas and Louisiana) prior authorization inquiry, call: 844-282-3025, TTY 711. Available Monday - Friday, 8 a.m. - 5 p.m., CST
- Medicare Advantage: for a Texas prior authorization inquiry, call: 844-282-3026, TTY 711. Available Monday - Friday, 8 a.m. - 5 p.m., CST
- Medicare Advantage: for a New Mexico prior authorization inquiry, call: 844-282-3026, TTY 711. Available Monday - Friday, 8 a.m. - 5 p.m., GMT
- US Family Health Plan: for a prior authorization inquiry, call: 800-446-1730, TTY 711. Available Monday - Friday, 8 a.m. - 5 p.m., CST
Effective 01/01/2025
- Louisiana Health Individual and Family Plan
- Texas Health Individual and Family Plan
- US Family Health Plan
- New Mexico Medicare Advantage
- Texas Medicare Advantage
- NCHD
If you have any questions about the CHRISTUS Health Plan Prior Authorization list(s), please contact Member Services at 1-844-282-3100.
Prior Authorization Forms
Please complete the prior authorization form for your Individual and Family plan, Medicare Advantage plan, or US Family Health plan (USFHP).
Individual and Family Plan
- Texas Health Insurance Exchange Prior Authorization Form (PDF)
- Louisiana Insurance Exchange Prior Authorization Form (PDF)
- Hemo Dialysis Transplant Evaluation and Transplant Form (PDF)