As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Box 660027Dallas, TX 75266-0027, Prior authorization of Medical Services for the Health Insurance Marketplace for Blue Advantage HMO Members, Eligibility and benefits contact Availity or other electronic connectivity vendor or call 800-451-0287*, Behavioral health services mental health and chemical dependency, For prior authorization and referrals managed by BCBSTX: (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services). Authorizations & Referrals is an online tool in the Availity Provider Portal that allows you to submit prior authorization and/or referral requests handled by Blue Cross and Blue Shield of Texas (BCBSTX). O. Fax Number. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Provider Network Representative at BCBSTX Plano, Texas, United States. Normally, most requests are processed within seven to 10 business days. Most PDF readers are a free download. Explore this site for useful tools and information. To request bundling logic, access Clear Claim Connection. } 1-800-637-0171, press 3 or 1-713-663-1149 Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. TRS-ActiveCare Primary+ Contact Us | HealthSelect of Texas | Blue Cross and Blue - BCBSTX 1800 West Loop South, Suite 600 Most PDF readers are a free download. We were told that if we send a complaint to the Texas Department of Insurance (TDI), we will not receive a response from BCBSTX. One option is Adobe Reader which has a built-in reader. Select the "Network Type" from the drop down list Choose the plan listed on the member's ID card Provide your email address to get our Blue Review newsletter electronically! Have you visited ourFrequently Asked Questions page? For (BlueCard) out-of-state members you should call 1-800-676-BLUE (2583), voice the three-character prefix at which time you will be transferred to the members plan where they can disclose the members eligibility and benefits. It will open in a new window. Each plan that participates in the (BlueCard) out-of-state program is assigned prefixes by the Blue Cross Association (BCA). This new site may be offered by a vendor or an independent third party. Non-Discrimination Notice. Houston, TX 77027, 3223 S. Loop 289 P. O. learn about other convenient ways to pay your bill. You can save quotes for later or apply now. Authorizations & Referrals submissions At the request of the physician/provider, refunds will be processed for any amount owed. Why? Log in to your account to get the most accurate, personalized search results based on your plan. Anthem: Blue Cross Blue Shield of Georgia X. Providers can electronically document their patients care and assessments to close quality HEDIS care gaps for BCBSTX members using CQV. If you are instructed to file your claim direct to another plan, then all correspondence to include claim reviews should be sent directly to that plan also. As of August 16, 2003, for those groups or accounts subject to Texas Prompt Pay Legislation, BCBSTX is limited to 180 days from the date payment is received in your office. The members home plan has the final decision on the allowed amounts for services that are rendered. *interactive voice response (IVR) system to access, you must have document control number (claim number), Eligibility and benefits contact your electronic connectivity vendor, Availity or other electronic connectivity vendor or call 800-451-0287*. Please keep in mind that BCBSTX provides the most current information possible at the time of each inquiry. BCBSTX Provider Relations Representative is also available to provide assistance as needed. Corpus Christi, TX 78411, 1001 E. Lookout Drive Yes. For a better experience, please update or consider using a different browser. Process improvements are being made in this area. Maintenance Notification: Contact Us Contact Name Address/Phone/Email/URL Blue Cross and Blue Shield of Texas (BCBSTX) 1001 E. Lookout Drive Richardson, TX 75082 800-451-0287 TDD: 800-735-2989 (for hearing impaired) BCBSTX provider portal Electronic Commerce Services For information about Electronic Data Interchange (EDI) transactions, such as electronic claim submission Learn More. Home I'm a provider in a BCBSTX network and have a question: Please visit ourProvider Contact Us pageto find the correct point of contact. The city of Neuilly-sur-Seine is a big french city located north central of France. To access the provider search tool on the new, custom website: Follow the link to www.bcbstx.com/trscarestandard. For our self-funded Administrative Services Only (ASO) agreements, it is contingent upon the groups guidelines and notification to BCBSTX. It was designed to help providers manage their administrative tasks as quickly and efficiently as possible. BCBSTX will not respond directly to you once a complaint has been received from TDI. Dependent Student Medical Leave Certification Form, Medicare Advantage Annual Wellness Visit guide, Medicare Advantage Annual Wellness Visit Form, Out-of-Network Enrollee Notification Form for Regulated Business (Use this form if "TDI" is on member's ID card), Out-of-Network Enrollee Notification Form for Non-Regulated Business (Use this form if "TDI is not on member's ID card), PPO Notification for non pre-cert surgeries per Texas Administrative Code 3.3703, Urine Drug Testing Form for Out-of-Network Providers, Wheelchair Medical Necessity and Home Evaluation Verification, Mental Health Forms for Employee Retirement System of Texas (ERS), Behavioral Health Forms for Teacher Retirement System of Texas (TRS), Supervision via Telehealth Request Attestation, Intensive Outpatient Program (IOP) Request, Psychological/Neuropsychological Testing Request, Repetitive Transcranial Magnetic Stimulation (rTMS), Accredo Specialty Pharmacy General Use Fax Form, Accredo Specialty Pharmacy Referral Forms by Therapy, Fax forms must be faxed from a physician's office, Specialty pharmacy drugs fax form for general use, Specialty pharmacy drugs fax form by drug therapy, Request to override the dispensing/quantity limit. Blue Access for Members and quoting tools will be unavailable from 2am - 5am Saturday, October 20. * (Blue Essentials and Blue Advantage HMO), Prior Authorization Services For Fully Insured and ASO, Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO), Prior Authorizations Lists for Designated Groups, Prior Authorization Exemptions (Texas House Bill 3459), Medicare Advantage Private Fee-for-Service (PFFS), Eligibility and Benefits Inquiry (HIPAA 270/271), Behavioral Health Care Management Program, Quality Care Partner With Your Patients, Preventive Care Guidelines/Patient Wellness Guidelines, Health Equity and Social Determinants of Health (SDoH), Prescription Drug List and Prescribing Guidelines, Prior Authorization and Step Therapy Programs, Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members, Consolidated Appropriations Act and Transparency in Coverage Final Rule, Email to submit provider inquiries and questions. www.pages02.net PDF OptiNet Assessment Process Frequently Asked Questions Learn More, Clinical Quality Validation (CQV) is a web-based application in the Availity Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS) measures. Get one now. Report. You can save quotes for later or apply now. Find a Doctor or Hospital Access and download these helpful BCBSTX health care provider forms. To request a sample of maximum allowable fees or if you have any questions, contact your local Professional Provider Network office. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. Behavioral Health Facilities Psychiatric FacilitiesResidential Treatment Centers for Mental Health andSubstance Abuse FacilitiesNote: For behavioral health professional providers, refer to the Network Management Office Locations listed above. You can share these with your employees to educate them on their HealthSelect medical benefits and resources. Simply select Get a Quote and you can view and compare our plans and pricing. C3 "mirrors" how BCBSTX's current code auditing software evaluates code combinations during the adjudication of a claim. The Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. If you are unable to find the Medical Policy you are looking for, complete and submit the Single Edit Request Form. In addition, some sites may require you to agree to their terms of use and privacy policy. In addition, if the member is subject to Texas Prompt pay Legislation you may request a Verification which is a guarantee of payment regardless if their coverage changes retroactively. Refer to the COVID-19 Preparedness page for temporary information related to servicing members in response to COVID-19. group.height(tallest); To avoid a recoupment, you may refund the balance due by following the instructions found in the notice you receive. 1001 E. Lookout Drive Obtaining a provider record only loads you in the system for claims processing purposes. Electronic claims filing system, Benefit disclosure information (form available online), Recommended Clinical Review (RCR) Requests (formerly Predeterminations ), Online: Use Availity Attachments application, Mail RCRform to: Provider_Relations_South_Texas@ BCBSTX.com Phone: 1-915-496-6600, press 2 Fax: 1-915-496-6614. Facility Provider Representative Blue Cross Blue Shield of Texas 2008 . To learn more about TriWest, visit the About section of this site. You can also contact your local network management representative with any questions you may have. We are reviewing our current membership processes and working with our employer groups to update their eligibility information as quickly as possible. Learn More. Blue Access for Members and quoting tools will be unavailable from 3am - 6am on Saturday, October 20. Mail your payment to the address on your invoice orlearn about other convenient ways to pay your bill. PDF Instructions for Completing - BCBSTX Building B, 14th Floor It is unique. Most fully insured cards do not currently reflect the employer's name. Fax: 1-713-663-1227 Box 660044Dallas, TX 75266-0044For status call:800-451-0287* (Blue Choice PPO), 877-299-2377* (Blue Essentials and Blue Advantage HMO) 877-774-8592 (Blue Cross Medicare Advantage PPO & HMO). All non-PPO BlueCard member ID cards must include the designated blank suitcase logo. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. This new site may be offered by a vendor or an independent third party. The Provider Claim Summary or EOB indicates the patient share. Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. For providers joining an existing group, you may contact your assigned Network Management Consultant once the provider record has been established using the provider onboarding process. What is the length of time that a physician or other professional provider can be out of the network before they have to be fully credentialed again?M. As with any member, benefits should be obtained prior to providing services. BCBS Provider Phone Number - Anthem Blue Cross and Blue Shield List This new site may be offered by a vendor or an independent third party. Is applying for a provider record with BCBSTX the same as applying for participation in your PPO/HMO networks? Fax: 361-852-0624 If it has been over 30 days, then the physician or other professional provider will need to be fully credentialed again. You can then search for a medical policy using a CPT, HCPCS, ICD-9 code, policy title, or view the table of contents. equalHeight($(".doc-hosp-member-bot")); You will need to sign-up on theAvaility website and refer to Availity Authorizations & Referral for more information. I'm a member with a question for customer service: Monday Friday: 7 a.m. 8 p.m. CT 800-713-4173 (Blue Card Preferred Provider Organization - Claims) 800-676-2583 (Blue Card Prferred Provider Organization - Eligiblity) Excellus: 800-920-8889: Western New York: 800-950-0051 (Traditional Plans) 800-950-0052 (Managed Care Plans) 800-234-6008 (Federal Employee Program) Northeastern New York: Blue shield : 800-444-4552 800-429-9886 . Legal and Privacy To access BCBSTX general reimbursement information policies, request forms for allowable fees and fee schedule information, visit the General Reimbursement Information section of the site. It will open in a new window. 972-766-8900 / 1-972-766-8900 Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. Q. If you need help, weve created these helpful guides: You must file your secondary claim to BCBSTX for Blue EssentialsSM, Blue Advantage HMOSM, Blue PremierSM, and MyBlue HealthSM, 180 days after the primary carrier paid or denied services. PDF Employer Representative Authorization Form - Blue Cross and Blue Shield Don't have one? Amarillo, TX 79124, 9442 Capital of Texas Highway, North Phone: 1-972-766-7100 No. MICHELIN Neuilly-sur-Seine map - ViaMichelin The Patient Cost Estimator is a member liability estimator tool. A. (BlueCard) out-of-state appeals should be filed to the same address that the claim was filed. Providers should submit all PC3 claims to PGBA within 30 days for timely reimbursement. I have questions about enrolling in a new plan: Monday Friday: 8 a.m. 8 p.m. CT In addition, some sites may require you to agree to their terms of use and privacy policy. The Claim Review form is available on this site under Downloadable forms. Blue Cross and Blue Shield of Texas1001 E. Lookout DriveRichardson, Texas 75082, General Information: 972-766-6900TTD: 735-2989. Blue Cross and Blue Shield of Texas (BCBSTX) is expanding the MyBlue Health SM network, effective Jan. 1, 2022 for Bexar, Travis and Williamson Counties. Most PDF readers are a free download. External link You are leaving this website/app (site). Email Us. Prior Authorization Services For Fully Insured and ASO, Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO), Prior Authorizations Lists for Designated Groups, Prior Authorization Exemptions (Texas House Bill 3459), Medicare Advantage Private Fee-for-Service (PFFS), Eligibility and Benefits Inquiry (HIPAA 270/271), Behavioral Health Care Management Program, Quality Care Partner With Your Patients, Preventive Care Guidelines/Patient Wellness Guidelines, Health Equity and Social Determinants of Health (SDoH), Prescription Drug List and Prescribing Guidelines, Prior Authorization and Step Therapy Programs, Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members, Consolidated Appropriations Act and Transparency in Coverage Final Rule. Learn More, The Availity Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSTX. In addition, some sites may require you to agree to their terms of use and privacy policy. One option is Adobe Reader which has a built-in reader. Provider Network Representatives are available to assist you Monday - Friday (8am-5pm) Fax: 1-866-290-7718 County-level maps of each region available at the end of this document. Please select from the categories below to find the section that best fits the subject matter of your question(s): No. Office: 1800 West Loop South, Ste 600 Houston, TX 77027 . Q: How do I apply for a provider record with BCBSTX?A: You must obtain from Blue Cross and Blue Shield of Texas (BCBSTX) a provider record by completing the Provider Onboarding Form located on our website under the network participation section then select Provider Onboarding Process. All BlueCross BlueShield plans have replaced their members Social Security number with a Unique Identifier. Call Customer Service at the number listed on your member ID card. It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment. group.css("height","auto"); Is there a limit to how far back BCBSTX will request a refund?A. Email to submit provider inquiries, Phone: 1-972-766-1380 Corpus Christi. You can access information regarding Provider Finder, Medical Policies, Downloadable Forms, Blue Review, online Availity Authorizations & Referrals, Pharmacy & Prescribing Guidelines, Wellness Guidelines, General Reimbursement Information, Provider Manuals, Electronic Commerce and Credentialing/Contracting and Availity. (out-of-state subscribers) Claim information is transmitted to a members plan electronically. Lubbock, TX 79423, 17806 IH 10 West, Building 2, Suite 200 Learn More, The National Drug Code (NDC) Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes to NDC units. Changes and updates are periodically made to the three-character prefixes assigned to the various BCBS plans. PDF Monday - Friday (8am-5pm) Fax - BCBSNM There, you'll find information that can help you log in to and use your Blue Cross and Blue Shield of Texas (BCBSTX) member account, understand your health insurance plan and answer some of our members' most common questions. is not correct on the website or I have added a sub-specialty. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. The site may also contain non-Medicare related information. Before the Customer Advocate can release the allowed amounts to you, there is a disclaimer that must be read to you. 114 Mesa Park Dr. Suite #300 Learn More, Clear Claim Connection (C3) is a web-based code auditing tool, designed by McKesson Information Solutions, Inc., that enables BCBSTX to disclose our claim auditing rules and clinical rationale to our contracting provider network. 512-349-4853. Where do I send refunds?A. To view this file, you may need to install a PDF reader program. BOX 660044, Dallas, TX 75266-0044. IMPORTANT: Existing Users Prior to Logging onRead More: Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). View Provider Manuals. Sherri Nalepa - Provider Relations Representative - BCBSTX - LinkedIn 1-713-663-1149 Yes. Yes, unless advised otherwise when obtaining eligibility and benefits. You may contact Provider Customer Service to determine the duration of the rider/exclusion. Utilization management/Medical Management/Case Management, Blue Cross and Blue Shield of Texas1001 E Lookout DriveRichardson, TX 75082-4144361-878-1623Fax: 361-852-0624Email to submit provider inquiries and questions, Blue Cross and Blue Shield of TexasArboretum Plaza II9442 Capital of Texas Hwy N, Suite 500Austin, TX 78759-7228800-336-5696512-349-4847Fax: 512-349-4853Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas4444 Corona, Suite 148Corpus Christi, TX 78411-4375361-878-1623Fax: 361-852-0624 Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas114 Mesa Park Dr. Suite #300El Paso, TX 79912 -6156915-496-6600, press 2Fax: 915-496-6614 Email to submit provider inquiries and questions, Golden Triangle (Beaumont, Orange, Port Arthur), Blue Cross and Blue Shield of Texas2615 Calder St, Suite 700Beaumont, TX 77702-1954800-637-0171, press 3 or 713-663-1149Fax: 713-663-1227 Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas1800West Loop South, Suite 600Houston, TX 77027-3279800-637-0171, press 3713-663-1149Fax: 713-663-1227 Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas4444 Corona, Suite 148Corpus Christi, TX 78411-4375361-878-1623Fax: 361-852-0624Email to submit provider inquiries and questions, North Texas Dallas, Fort Worth, East Texas (Excludes McLennan and Wichita counties), Blue Cross and Blue Shield of Texas1001 E. Lookout DriveRichardson, TX 75082-4144800-749-0966972-766-8900Fax: 972-766-2231Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas17806 IH 10 West, Bldg II, Suite 200San Antonio, TX 78257-8222361-878-1623Fax: 361-852-0624 Email to submit provider inquiries and questions, Phone: 713-354-8140Fax: 713-663-1227Email to submit provider inquires, AmbulanceIP Only Rehab Facilities ImagingLTAC (Long-Term Acute Care Hospital)Radiation Therapy Center, Phone: 972-766-4628Fax: 972-766-2231Email to submit provider inquires, Home HealthSkilled Nursing FacilitiesPost-Acute Brain Injury Facilities, Phone: 210-558-5101Fax: 210-558-5176Email to submit provider inquires, Diabetic ManagementDisease ManagementDurable Medical Equipment (DME)Hearing Aid SupplierProsthetics/Orthotics Sleep Studies Centers, Phone: 972-766-1613Fax: 210-340-1401Email to submit provider inquires, Home Infusion TherapyHome Health DialysisHospiceRenal Dialysis, Phone: 972-766-5125Fax: 210-340-1401Email to submit provider inquires. One option is Adobe Reader which has a built-in reader. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, I have a question for the membership department: Blue Cross and Blue Shield of Texas Opti MyBlue Health members in these areas will access care through providers contracted in the MyBlue Health network.Note these additional counties have no impact on the current MyBlue Health network benefits applicable to Dallas . P.O. Claims should be filed electronically whenever possible. Individual & Family I have questions about enrolling in a new plan: 1-800-531-4456 Monday - Friday: 8 a.m. - 8 p.m. CT Register now Austin. We are told that BCBSTX has no record of the claim review. PDF OptiNet Assessment Process Frequently Asked Questions Note:Review each form to determine the appropriate form to use. BCBS TX Provider Quick Reference Guide (PDF) DCHP Provider Quick Reference Guide (PDF) Texas State Bill 1742: Preauthorization requirements Preauthorization requirements for Blue Cross and Blue Shield of Texas commercial plans (PDF) Magellan's annual preauthorization report for BCBSTX commercial plans (PDF) View Documents. 1,000+ Intern Jobs in Neuilly-sur-Seine, le-de-France - LinkedIn Eligibility and benefits Upon receipt of the additional information from the other source, if the information alters our decision, additional payment or refund notice will be issued accordingly. A library of educational tools for you and your patients. Sr. Provider Network Representative - BCBSTX - LinkedIn Doctors in your plan network* To view this file, you may need to install a PDF reader program.
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