Prior Authorization

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.

Find out more information about the clinical criteria used by CHRISTUS Health Plan here.

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.

For Individual and Family Plan (Texas and Louisiana) prior authorization inquiry, call:1-888-315-0691, 711 for TTY

For MA prior authorization inquiry, call:1-855-562-1546 TTY at 711

For US Family Health Plan prior authorization inquiry, call: 1-877-893-7502, 711 for TTY

Effective 01/01/2024

• 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)
• New Mexico Insurance Exchange Prior Authorization Form (PDF)
• Louisiana Insurance Exchange Prior Authorization Form (PDF)
• Hemo Dialysis Transplant Evaluation and Transplant Form (PDF)

Medicare Advantage Plan

• Medicare Advantage Prior Authorization Form (PDF)

US Family Health Plan (USFHP)

• USFHP Prior Authorization Form (PDF)
• USFHP Prior Authorization Form Instructions (PDF)
• USFHP Prior Authorization Notice (PDF)

Authorization Reports

• Approval and Denials with Overturns
• Indications Offered by Provider Specialty

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