Accumulator Information on Eligibility and Benefits
Blue Cross and Blue Shield of Texas (BCBSTX) is pleased to announce that our member benefit quotes does now include accumulator information. The additional member liability information is intended to assist physician offices, hospitals and other health care constituents in understanding a Texas member’s liability amounts that have been met year-to-date (YTD).

Accumulator information has been made available through BCBSTX and can be accessed through various channels - telephonic and electronic. More specifically, the information can be obtained through the BCBSTX Interactive Voice Response (IVR) system, as well as the Availity gateway.

The following information outlines additional details regarding accumulators:

Automated Phone System

Effective September 15, 2008 BCBSTX Provider Services automated phone system includes (as applicable) member liability amounts met year-to-date.

The following are provided for both individual and family policies:

• Deductible
• Out-of-pocket
• Maximums (Lifetime, Yearly)
• Number of visits for both BCBSTX individual and family policies

The automated phone system number is 1-800-451-0287.

Availity

Effective today, accumulator amounts for BCBSTX members are available through Availity. Other vendors receiving eligibility and benefits information for BCBSTX members through Availity’s gateway will also receive member liability information on eligibility and benefits responses.

The responses will include the following:

• Deductible
• Out-of-Pocket
• Maximums (Lifetime, Yearly)
• Number of visits for both BCBS Texas individual and family policies

To learn more about Availity and its services, please visit their Web site at www.availity.com or contact them at 800-AVAILITY (282-4548).

Please note in the event the accumulations are not available, you will be directed to contact BCBSTX Provider Customer Service. We are working to minimize exceptions.

Helpful Hints: Electronic Transaction Types 270- Eligibility and Benefit Request 271- Eligibility and Benefit Response

Note: Unless otherwise required by state law, the benefit transaction is not a guarantee of payment. Benefits are subject to all contract limits and the member’s status on the date of service. Accumulated amounts such as deductibles may change as additional claims are processed. 

posted 10/2008