Prior Authorization and Referrals

Doctors and Hospital

When picking a doctor, you do not need an authorization for an in-network doctor. If you want to see a Medicaid doctor out of network, work with your service coordinator so arrangements are made to get authorizations for your out-of-network provider. To learn more about how to select a primary care provider (PCP), please refer to the STAR Kids Member Handbook.

Do you need help getting to a medical appointment? See transportation services.

You can also contact your service coordinator with any questions or concerns.

  • Your right to protect your needs, and understand the information and care you receive
  • Your responsibility to give your providers the information they need to take care of you
  • How to file a complaint
  • How to report health care fraud

If you have questions, please call Service Coordination toll-free at 1-877-301-4394.

Prior Authorization and Referrals

Prior authorizations are not needed for in-network PCPs or other providers. Your child's PCP may send you to a different provider, including a specialist, for special care or treatment. A referral to an in-network specialist is not needed. Blue Cross and Blue Shield of Texas (BCBSTX) will allow members to see out-of-network Medicaid specialists for medically necessary services.

OB/GYN Providers

BCBSTX also allows members to see out- of-network OB/GYN providers for medically necessary services. You should notify a service coordinator if you are going to see an out of network OB/GYN to ensure that the provider is loaded in our system so that they can file claims.

Behavioral Health and Substance Abuse Treatment Services

You do not need a referral for behavioral health or substance abuse treatment services to see a Magellan network provider. BCBSTX STAR Kids members get behavioral health/substance abuse services through Magellan Health Services. If you want to see an out-of-network provider, you need to get a prior authorization for to ensure Magellan has the provider information needed to accurately pay claims. A Magellan Health Care Coordinator will work with your child’s service coordinator to ensure your child has access to the behavioral health services needed. You can also call Magellan at 1-800-424-0324.

Emergency Care and Urgent Care

Emergency or urgent care does not require authorization. You do not need an OK from us or need a referral from your PCP to see a family planning care provider. You can contact your child's service coordinator for help scheduling an appointment at 1-877-301-4394 or call Customer Service at 1-877-688-1811.

Learn How Your Plan Works

To learn more about prior authorization and referrals, see the Member Handbook

Find a Doctor or Hospital 

Use our Provider Finder® to search for doctors and other health care providers near you.

Contact Us

  •  1-877-688-1811 (TTY 711)
  • 8 a.m. to 8 p.m. Central Time Monday through Friday
  • Contact Us