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.
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.
Updates to the Prior Authorization List are in progress. USFHP Medical Injectables (J and Q codes) PA list is now available for review. Please continue to check this page for the most current information and upcoming changes.
LA HIX: Health Exchange/ Individual and Family Plan, LA ; TX HIX: Health Insurance exchange/ Individual And Family Plan, TX
*Turnaround times listed in this TAT grid are subject to change based on applicable regulatory requirements and updates to Utilization Management (UM) guidelines. Timelines may be adjusted to ensure ongoing compliance with federal, state, and accreditation standards.
| Line of Business | Urgent / Expedited | Concurrent | Routine |
|---|---|---|---|
| LA HIX | 2 Business Days | 48 Hours | 5 Business Days |
| TX HIX | 1 Business Day | 1 Business Day | 2 Business Days |
| USFHP (TRICARE) | 1 Business Day |
ER Admission - 1 Business Day Elective Admission - 3 Business Days |
90% ≤ 2 Business Days 100% ≤ 5 Business Days |
| Medicare Advantage | 72 Hours | 72 Hours | 7 Calendar Days |
All Texas Individual & Family Health Exchange Plan providers should utilize the Texas Standard Prior Authorization Form for Health Care services and submit prior authorization requests via fax to 844-357-7562.
Nueces County Hospital District (NCHD) providers should utilize the Texas Standard Prior Authorization Form for Health Care services and submit prior authorization requests via fax to 844-357-7562.
Disclaimer: These Medicare Advantage prior authorization metrics are published in accordance with the CMS Interoperability and Prior Authorization Final Rule (CMS‑0057‑F). Metrics reflect aggregate data for the reporting period (Year 2025) and are subject to validation and updates. The metrics will be updated on an annual basis.
For any other provider related inquiries, please call Member services at 844-282-3100.
Last Updated Date: 3/17/26
