| Contact Name | Address/Phone/Email/URL | |
|---|---|---|
Blue Cross and Blue Shield of Texas (BCBSTX) |
1001 E. Lookout Drive Richardson, TX 75082 1-800-451-0287 TDD: 1-800-735-2989 (for hearing impaired) |
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BCBSTX Provider Customer Service Numbers |
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BlueCard® |
Eligibility and benefits Claim status inquiries (out-of-state subscribers) contact Availity® or other electronic connectivity vendor. Claim adjustments call 1-800-451-0287* *interactive voice response (IVR) system — to access, you must have document control number (claim number) |
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Blue Choice PPOSM and indemnity plans |
Eligibility and benefits contact your electronic connectivity vendor, Availity or other electronic connectivity vendor or call 1-800-451-0287* Claim status inquiries contact Availity or other electronic connectivity. Claim adjustments call 800-451-0287* *interactive voice response (IVR) system – to access, you must have document control number (claim number) |
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Refer to BCBSTX Medicaid website and Contact Us. Medicaid Network Management Email to submit provider inquiries and questions. |
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Blue Cross Medicare Advantage |
Customer Service 1-877-774-8592 |
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Care Management Programs |
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Federal Employee Program® (FEP®) — PPO |
Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-800-442-4607* Claim status inquiries contact Availity or other electronic connectivity. Claim adjustments call 1-800-451-0287* *interactive voice response (IVR) system — to access, you must have document control number (claim number) Behavioral health services mental health and chemical dependency prior authorization and referrals (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services) call 1-800-528-7264 Behavioral health services – claims status inquiries contact Availity or other electronic connectivity vendor or call 1-800-442-4607* Behavioral health services – claim adjustments call 1-800-442-4607 |
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Blue Essentials |
Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-877-299-2377* Claim status inquiries contact Availity or other electronic connectivity vendor Claim adjustments call 1-877-299-2377* *interactive voice response (IVR) system – to access, you must have document control number (claim number) |
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Medical Management Correspondence for the Health Insurance Marketplace for Blue Advantage HMO Members |
Fax: 866-589-8254 Blue Cross Blue Shield of Texas |
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Prior authorization of Medical Services for the Health Insurance Marketplace for Blue Advantage HMO Members |
Fax: 866-589-8253 |
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University of Texas (UT Select) |
Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-800-451-0287* Claim status inquiries contact Availity or other electronic connectivity vendor Claim adjustments call 1-877-299-2377* *interactive voice response (IVR) system – to access, you must have document control number (claim number) |
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Other Important Contacts |
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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) Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. Submit completed forms to: Claims submission address: For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc. 1-800-729-2422 |
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Behavioral health services - claims status inquiries |
For services managed by BCBSTX: *interactive voice response (IVR) system — to access, you must have full member's information (for example, member's ID, patient’s date of birth, etc.) For services managed by Magellan: |
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Prime Therapeutics |
Pharmacy help desk: 1-888-229-2812 For PPO questions: 1-800-521-2227 For HMO questions: 1-877-299-2377* *interactive voice response (IVR) system - to access, you must have full member's information (for example, member's ID, patient's date of birth, etc.) |
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Carelon Medical Benefits Management (Carelon) |
1-800-859-5299 Carelon ProviderPortal |
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eviCore healthcare |
1-855-252-1117 or online at eviCore | |
Claim filing address for Commercial products |
All claims should be filed electronically. If a provider must file a paper claim, mail claim to Blue Cross and Blue Shield of Texas P.O. Box 660044 Dallas, TX 75266-0044 |
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Claim review submission address |
Blue Cross and Blue Shield of Texas P.O. Box 660044 Dallas, TX 75266-0044 Request for claim review form and instructions |
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Availity® Essentials |
File electronic claims using Payer ID #84980 Submit prior authorization and referrals for BCBSTX managed services via Authorizations & Referrals Availity client services 1-800-AVAILITY (282-4548) Availity website EDI Guide |
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Benefit disclosure information (form available online) |
Send requests to: Blue Cross and Blue Shield of Texas Pre-Service Allowed Benefit Disclosure Request P.O. Box 650489 Dallas, TX 75265-0489 Fax: 1-972-766-0371 Please do not send patient-specific predetermination information to this address or fax number. |
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Recommended Clinical Review (RCR) Requests (formerly Predeterminations ) |
Submit RCR requests: Online: Use Availity Attachments application Mail RCR form to: 1-877-299-2377* (Blue Essentials and Blue Advantage HMO) 1-877-774-8592 (Blue Cross Medicare Advantage PPO & HMO) *interactive voice response (IVR) system - to access, you must have full member's information (for example, member's ID, patient's date of birth, etc.) Note: Recommended Clinical Review requests for members with Blue Cross and Blue Shield benefits in another state should be sent to the Plan indicated on the member’s ID card. |
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Utilization Management/Medical Management/Case Management |
Referrals and inpatient prior authorizations 1-800-441-9188 Fax: 800-252-8815 or 800-462-3272 Case management 1-800-462-3275 Fax: 800-778-2279 Messages may be left in a confidential voice mailbox after business hours. Wellness and clinical practice guidelines |
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Network Management Office Locations |
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All other inquiries – submit an email by selecting the office closest to your location and provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Network Management. TO AVOID DELAY, DO NOT SUBMIT FORM TO MULTIPLE AREAS/OFFICES. |
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Abilene, Midland San Angelo |
Blue Cross and Blue Shield of Texas |
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Austin and Central TX (Bastrop, Bell, Bosque, Burleson, Burnett, Caldwell, Falls, Fayette, Hays, Hill, Lee, Leon, Limestone, Madison, Milam, McLennan, Robertson, Travis, Williamson counties) |
Blue Cross and Blue Shield of Texas |
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Amarillo |
Blue Cross and Blue Shield of Texas |
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Corpus Christi and The Valley |
Blue Cross and Blue Shield of Texas |
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Dallas and East Texas |
See "North Texas" |
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El Paso |
Blue Cross and Blue Shield of Texas |
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Fort Worth |
See "North Texas" |
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Golden Triangle (Beaumont, Orange, Port Arthur) |
Blue Cross and Blue Shield of Texas |
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Houston |
Blue Cross and Blue Shield of Texas |
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Laredo |
See "San Antonio and Laredo" |
|
Lubbock |
Blue Cross and Blue Shield of Texas |
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McLennan County |
See "Austin and Central Texas" |
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North Texas Dallas, Fort Worth, East Texas (Excludes Bastrop, Bell, Bosque, Burleson, Burnett, Caldwell, Falls, Fayette, Hays, Hill, Lee, Leon, Limestone, Madison, Milam, McLennan, Robertson, Travis, Wichita and Williamson counties) |
Blue Cross and Blue Shield of Texas |
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San Angelo |
See "Abilene, Midland and San Angelo" |
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San Antonio and Laredo |
Blue Cross and Blue Shield of Texas |
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The Valley |
See "Corpus Christi and The Valley" |
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Wichita County |
See "Austin and Central Texas" |
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Ancillary Network Management |
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| Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Ancillary Network Management. | ||
Ambulance |
Fax: 1-713-663-1227 Email to submit provider inquiries |
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Ambulatory Surgery Centers (ASC) – Independent, Non-Hospital owned |
Fax: 1-713-663-1227 |
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Behavioral Health Facilities Only
(Note: For behavioral health professional providers, refer to the Network Management Office Locations listed above). |
Fax: 1-713-663-1227 |
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Birthing Centers |
Fax: 1-713-663-1227 Email to submit provider inquiries |
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| Catheterization Center | Phone: 1-713-354-7033 |
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| Diabetic Management | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Disease Management | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Durable Medical Equipment | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Freestanding Emergency Rooms | Fax: 1-713-663-1227 Email to submit provider inquiries |
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| Hearing Aid Supplier | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Home Health | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Home Health Dialysis | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Home Infusion Therapy | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Hospice | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Imaging | Fax: 1-713-663-1227 Email to submit provider inquiries |
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| Independent Clinical / Specialty Labs | Fax: 1-713-663-1227 Email to submit provider inquiries |
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| Independent Diagnostic Testing Facility (IDTF) Note: If provider’s primary specialty is Imaging, Lab or Sleep Lab, please refer to that specialty in this contact list | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Long term Acute Care Hospital (LTAC) | Fax: 1-713-663-1227 Email to submit provider inquiries |
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Physical Rehab Facilities -Inpatient |
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Post-Acute Brain Injury Facilities |
Fax: 1-210-340-1401 Email to submit provider inquiries |
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Prosthetics/Orthotics |
Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Radiation Therapy Center | Fax: 1-713-663-1227 Email to submit provider inquiries |
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| Renal Dialysis | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Skilled Nursing Facility (SNF) | Fax: 1-210-340-1401 Email to submit provider inquiries |
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| Sleep Studies Centers | Fax: 1-210-340-1401 Email to submit provider inquiries |
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Blue Cross Medicare Advantage
|
1001 E. Lookout Drive |
|