Some health care services require prior authorization before members receive them. If members do not follow our requirements for prior authorization, 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.
Generally, the following types of services require prior authorization:
- Durable Medical Equipment (DME)
- Home Health Care
- Skilled Nursing Facility Care
- Physical, occupational, and speech therapy
- Cardiology Procedures
- Hospice Services
- Clinical Trial Services
- Transplant Services
- Certain drug and medications
- Nuclear medicine
- Non-emergency ambulance transport
- Pain management
- Prosthetic appliances and orthotics
- Sleep studies
Note: This list may not include all services requiring Prior Authorization. If you need help determining if a service requires Prior Authorization, please contact Member Services at 1-844-282-3100.
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
Combined Prior Authorization List
Effective 1/01/2020 - 08/31/2020