Update on Confirming Eligibility for BCBSTX Members
(Updated January 14, 2014)
With the new federal requirement for individuals to have insurance coverage beginning January 1, along with new commercial groups with coverage starting January 1, Blue Cross and Blue Shield of Texas (BCBSTX) is pleased to be serving many new members. There are some important things to be aware of when verifying eligibility:
Member ID information: Member ID information: Members should receive their member ID card within days of completing their enrollment. However, some of your patients may not have received their member ID card at the time of their appointment. If they have their member identification number and group number from another source, such as their new member welcome letter or phone confirmation, we can verify eligibility and benefits.
- For patients who do not have this information, you should direct them to contact our Member Customer Service Center at 888-697-0683 to obtain their information. Or, reschedule their appointment to a later date.
- If the member is exhibiting an urgent need for inpatient services or admission and you are unable to verify their information, please contact 855-462-1785 for preauthorization.
Confirming coverage: As usual, coverage cannot be used until the member's first month premium payment has been applied to effectuate coverage. Also, benefits may vary depending on the coverage purchased by the member. It is important to check for eligibility and benefits each time you see a patient. We are experiencing high call volumes and increased hold times due to 2014 updates. At this time, please wait until patients have scheduled appointments before making eligibility and benefit inquires.
Network terms: We want to stress the importance of confirming your network status for the member's plan before services are provided. As a reminder, the terms of your network contract prevent you from refusing to provide services to a BCBSTX member, irrespective of where they purchased their coverage. Care provided for emergency conditions will follow our standard authorization process.