For most of our members, if you cannot submit your eligibility and benefit inquiries online, this information can also be easily obtained through our IVR automated phone system. If you have questions or need to request a claim adjustment, a document control number (claim number) is required.
- You may access the IVR by calling Provider Customer Service at 1-800-451-0287. Hours of availability are: Monday through Friday, 6 a.m. – 11:30 p.m. (CST), and Saturday, 6 a.m. – 6 p.m. (CST).
- Simply provide your National Provider Identifier when prompted* (you may speak or enter your information by touch-tone).
* Providers who do not have an NPI or are calling from out-of-state may speak or enter their tax ID number when prompted by the IVR; however, these providers must specify their provider type, specialty and network status to receive a quote of benefits.
NPI Guidelines**
- Physician or solo practitioner must use the Type 1 (rendering) NPI number.
- Physicians or practitioners that have incorporated with both a Type 1 & Type 2 (billing) NPI must use the Type 1 NPI number.
- Physicians or practitioners that are part of a group practice must use the rendering provider's Type 1 NPI number.
- Radiologists, anesthesiologists and other medical providers must use the Type 1 NPI number.
- Medical Groups must use the rendering provider's Type 1 NPI for the rendering provider.
- DME suppliers must use the Type 2 NPI for the specific location.
- Labs and other ancillary providers must use Type 2 NPI for the entity.
- Facilities must use the Type 2 NPI number.
** The NPI guidelines were established to help support and clarify the use of NPI numbers when inquiring about eligibility and benefits as well as claim adjustments for our members.
Caller Guides
- Behavioral Health Inpatient Prior Authorization Caller Guide (Non-FEP)
- Behavioral Health Outpatient Prior Authorization Caller Guide (Non-FEP)
- Check Authorization by Procedures Code Caller Guide
- Check Prior Authorization Status Caller Guide
- Claims Caller Guide
- Eligibility and Benefits Caller Guide
- Inpatient Prior Authorization Caller Guide
- Outpatient Prior Authorization Caller Guide
- Referral Request Caller Guide
* Providers who do not have an NPI or are calling from out-of-state may speak or enter their tax ID number when prompted by the IVR; however, these providers must specify their provider type, specialty and network status to receive a quote of benefits.
** The NPI guidelines were established to help support and clarify the use of NPI numbers when inquiring about eligibility and benefits as well as claim adjustments for BCBSTX members.