BCBSTX New Employer Group Plan – Employees Retirement System of Texas (ERS) Effective Sept. 1, 2017

We are excited to announce that Blue Cross and Blue Shield of Texas (BCBSTX) was awarded the six-year contract for the Employees Retirement System of Texas (ERS) account, effective Sept. 1, 2017. ERS participants covered under HealthSelect^SM of Texas and Consumer Directed HealthSelect^SM benefit plans will access care through the Blue Essentials^SM provider network in all 254 counties in Texas.

ERS participants plan options:

HealthSelect of Texas In-Area (Texas)

• Participants must select a primary care physician (PCP) participating in the Blue Essentials provider network and referrals are required to see Blue Essential providers for in network benefits.

Consumer Directed HealthSelect In-Area (Texas)

• Consumer Directed HealthSelect participants have open access to providers in the Blue Essentials provider network for their in-network benefits. This plan does not require PCP selection and does not require referrals.

ERS participants can be identified through their BCBSTX ID card:

• The plan names HealthSelect of Texas and Consumer Directed HealthSelect will be printed directly on the ID card.
• ERS Participants will have a unique Blue Essentials network ID labeled HME.

Patient eligibility and benefits should be verified prior to every scheduled appointment. Eligibility and benefit quotes include participant verification, coverage status and other important information, such as applicable copayment, coinsurance and deductible amounts. It's strongly recommended that providers ask to see the participant's ID card for current information and photo ID to guard against medical identity theft. When services may not be covered, participants should be notified that they may be billed directly.

For a list of services that require prior authorization for ERS participants, refer to the ERS HealthSelect of Texas Prior Authorization/Notification/Referral Requirements List or ERS Consumer Directed Health Select Prior Authorization/Notification/Referral Requirements List on the Clinical Resources page of bcbstx.com/provider.

In addition, BCBSTX has contracted with eviCore healthcare (eviCore), an independent specialty medical benefits management company to provide Utilization Management services for the prior authorization requirements outlined below and indicated on the HealthSelect or Consumer Directed HealthSelect Prior Authorization/Notification/Referral Requirements lists for ERS participants:

• Molecular and genomic testing
• Radiation oncology for all outpatient and office services
• Advanced Radiology Imaging
• Sleep Studies and Sleep Durable Medical Equipment

To obtain prior authorization through eviCore you may use one of the following methods:

• The eviCore HealthCare Web Portal is available 24x7. After a one-time registration, you can initiate a case, check status, review guidelines, view authorizations/eligibility and more. The Web Portal is the quickest, most efficient way to obtain information.
• Texas Providers can call toll-free at 855-252-1117 between 6 a.m. to 6 p.m. (central time) Monday through Friday and 9 a.m. to noon on Saturdays, Sundays and legal holidays.

For all other services (not listed above), that require a referral and/or prior authorization, providers should refer to the telephone numbers on the participants' ID card or physicians, professional providers and facilities contracted with BCBSTX can access iExchange. Go to iExchange to learn more or set up a new account.

Continue to watch for additional information regarding ERS in future editions of the Blue Review newsletter and on our website at bcbstx.com/provider.

If you have any questions or if you need additional information, please contact your BCBSTX Network Management Representative.