Blue Cross and Blue Shield of Texas physicians and medical providers utilizing the Availity portal may, in certain situations, have received out-of-network benefit information instead of in-network benefits.  This may have occurred when providers submitted the transaction for the member’s eligibility and benefits status using the billing provider NPI rather than the rendering provider NPI.

The following guidelines were established to help support and clarify the use of NPI number when submitting eligibility and benefits inquiries for BCBS Texas members:

TYPE 1 NPI:
If a physician or medical provider is not part of a clinic (stand alone physician office) =

1. Physician must use the Type 1 NPI number.
2. Type 1 NPI numbers must always be used as the rendering NPI for physicians with both a Type 1 and Type 2 NPI number assigned. 
3. Labs, radiologist, pathologist etc = Entity must use the single NPI number associated with the entity contracted with BCBS Texas if multiple NPI numbers exist.   

TYPE 2 NPI:
If a physician or medical provider is part of a clinic =

1. Physician must use the rendering NPI number (Type 1) rather than the billing clinic NPI number.
2. Facilities must use the "Type 2" NPI number.

Note: Please continue to use the billing NPI for BCBSTX claim status transactions through Availity.

Please contact Availity Client Services at 800.AVAILITY (282.4548) Monday – Friday from 7:00 a.m. – 6:00 p.m. Central regarding questions on this communication.