Time To Get Started

Blue Cross and Blue Shield of Texas (BCBSTX) has been building strong relationships with physicians and other professional providers for over 60 years. And those relationships just keep getting better...

That's because providers who join our expansive BCBSTX network of participating physicians and other professional providers have more time to focus on their business and patients. Our specialized departments are designed with your success in mind to assist you each step of the way, from setting up your provider record with BCBSTX, to the network application all the way through the contracting process.  Just follow these easy steps to become a BCBSTX network provider:

Option 1 – Establish a BCBSTX Provider Record

Contact Provider Administration to ensure you have a provider record set-up with BCBSTX.  If you do not already have a provider record or would like to confirm your provider record, please contact Provider Administration at (972) 996-9610, press option 3.

Note:  Requesting a provider record from BCBSTX does not mean you are a participating provider in the BlueChoice® or HMO Blue® Texas provider networks.

• If you do not already have a record set-up with BCBSTX, please complete the following form:

  Solo Provider Record Information Form should be completed by:

  • A provider who will not be employing another professional provider
  • A provider who will be using his/her social security number for tax purposes
  • A provider whose Tax Identification Number (TIN) is legally in the provider's name
  • A provider who is not incorporated

  Group Provider Record Information Form should be completed by:

  • A provider who has a practice with more than one professional provider
  • A provider whose Federal Tax ID has a corporate legal name
  • If the billing entity is incorporated

To add a provider to an existing group, use the Group Member Information Form on page 4 of the Group Provider Record Information Form.

Forward Completed Provider Forms to:

Fax to:  Provider Administration

             972-996-8445 (preferred method)

or

Mail to:

Blue Cross and Blue Shield of Texas
Attn:  Provider Administration
P.O. Box 650267
Dallas, TX  75265-0267

• If you need the status of a previously submitted Provider Record Information Form or have questions regarding the completion of the Provider Record Information Form, please contact Provider Administration at (972) 996-9610, press option 3.

Option 2 – Submit a Fully Completed TDI Standardized Credentialing Application Packet and All Applicable Attachments

BCBSTX requires full credentialing of all physicians and other professional providers for their managed care networks, BCBSTX will provide an expedited credentialing process which allows for a “provisional network participation” status if the provider applicant

1. has a valid license in the state by, and in good standing with, the Texas Licensing Boards,
2. submits all documentation required to make an application complete, and
3. submits a current signed contract/agreement.

If BCBSTX is unable to verify license information, the applicant will be fully credentialed and made effective after credentialing approval.

if you are one of the following provider types that BCBSTX contracts with and would like to become a participating physician or other professional provider, submission of a fully completed Texas Standardized Credentialing Application packet is required:

• MDs and DOs 
• DDSs (oral and maxillofacial surgery) 
• Licensed Physical Therapists, Occupational Therapists, 
• Optometrists, Audiologists, Speech and Language Pathologists 
• Behavioral Health Providers* 
• Physician Assistants, Surgical Assistants, Advanced Practice Nurses, Certified Nurse Midwives, Registered Nurse First Assistants 
• Podiatrists 
• Chiropractors
• Acupuncturists 
• Certified Registered Nurse Anesthetists 

*The licensing board for Psychologists (PhDs) does not provide a quick verification method of a provider's license. PhDs will be fully credentialed and made effective after credentialing approval.

All applicants should utilize the TDI Credentialing Application Completion Guide to verify that they are submitting a full completed application packet. Incomplete application packets will be returned.

• Texas Standardized Credentialing Application (pages 1– 20) and all applicable documents. (CAQH Users, please contact CAQH for instructions in downloading your information in the TDI Credentialing Application)
• Behavioral Health Form - required to be submitted in conjunction with the credentialing application for all Behavioral Health Professionals with the exception of TRICARE Behavioral Health Professionals. Note: TRICARE Behavioral Health Professionals will need to complete and submit the form below.
• Behavioral Health Form/TRICARE – required to be submitted in conjunction with the credentialing application for all TRICARE Behavioral Health Professionals.
• Hospital Referral Letter - required to be submitted in conjunction with the credentialing application for those providers who do not have admitting privileges at a network hospital.
• Signed Contract/Agreement To request for a contract/agreement to be sent to you from BCBSTX, complete the online request form or contact your local Professional Provider Network office.
  
  Note:  Review the provider contract/agreement to fully understand your requirements for participation such as referrals to in-network facility/providers and other administrative services.

Local Professional Provider Network Department (PPND) Offices:

Forward Fully Completed Application Packet to:

Fax to:  Provider Administration

             972-996-8230 (preferred method)

or

Mail to:

Blue Cross and Blue Shield of Texas
Attn:  Provider Administration
P.O. Box 650267
Dallas, TX  75265-0267

Your completed Texas Standardized Credentialing Application packet will be processed. The BCBSTX credentialing committee will notify you in writing of their decision. Once approved, your PPND Representative will contact you to schedule an orientation at your convenience.

Option 3 – To Recredential an Existing Provider

To continue participation with BCBSTX’s managed care networks, a fully completed Texas Standardized Credentialing Application packet is required. Use of the TDI Credentialing Application Completion Guide to verify that you are submitting a fully completed application packet. Incomplete application packets will be returned.

• Texas Standardized Credentialing Application (pages 1-20) and all applicable attachments. (CAQH Users, please contact CAQH for instructions in downloading your information to the TDI Credentialing application.)
• Behavioral Health Form - required to be submitted in conjunction with the credentialing application for all Behavioral Health Professionals with the exception of TRICARE Behavioral Health Professionals. Note: TRICARE Behavioral Health Professionals will need to complete and submit the form below.
• Behavioral Health Form/TRICARE – required to be submitted in conjunction with the credentialing application for all TRICARE Behavioral Health Professionals.
• Hospital Referral Letter - required to be submitted in conjunction with the credentialing application for those providers who do not have admitting privileges at a network hospital.

Forward Fully Completed Application Packet to:

Fax to:  Provider Administration

             972-996-8230 (preferred method)

or

Mail to:

Blue Cross and Blue Shield of Texas
Attn:  Provider Administration
P.O. Box 650267
Dallas, TX  75265-0267

Time to Work Together

We know your time is valuable, and we also know that the rising cost of health care is a big concern for everyone. That's why we designed the following innovative systems, technologies and resources that provide time and cost saving approaches to health care management.

Online Resources for Faster Claims Payment

Automated Inpatient Precertification & Referral System
iEXCHANGE®
Access the Web application at http://www.bcbstx.com/provider/iexchange_home.htm 
Access the Interactive Voice Response (IVR) phone system by calling 1-800-413-0869

Electronic Data Interchange (EDI)
Availity L.L.C. - Patients.  Not Paperwork®
(800) 282-4548 or access Availity's Provider Portal

The Availity Health Information Network provides:

• Electronic Funds Transfer (EFT)
• Electronic Remittance Advice (ERA)
• Electronic Payment Summary (EPS
• Multiple Payer Solution
• No Charge for Health Plan transactions
• Eligibility and Benefits – real time
• Claims Status – real time
• Full Electronic Claims services   

For additional information on Availity.

Other Resources to Manage Time and Costs

Radiology Quality Initiative (RQI) and Preauthorization Program
American Imaging Management (AIM)
(800) 859-5299 or access AIM's Provider Portal

Ordering physicians or other professional providers must contact AIM to obtain an RQI number for the following outpatient services for BlueChoice members and a Preauthorization for HMO Blue Texas members when performed in a physician's/other professional provider's office or other outpatient setting:

• CT/CTA
• MRI/MRA
• PET scans
• SPECT/Nuclear cardiology studies

For additional information on the AIM program.

Specialty Drug Program
Triessant  
(888) 216-6710

Blue Cross and Blue Shield of Texas has in place an arrangement with Triessant to supply certain high cost injectable drugs to the office of participating physicians and other professional providers.

For additional information on the Specialty Drug Program.

Outpatient Clinical Reference Laboratory 
Laboratory Corporation of America (LabCorp)
(888) LABCORP (522-2677) or access LabCorp's Provider Portal

LabCorp is the preferred outpatient clinical reference laboratory provider for BlueChoice/BlueChoice Solutions members and is the exclusive outpatient clinical reference laboratory provider for HMO Blue Texas members. Please visit our provider Web site for additional information.

Behavioral Health
Physicians and other professional providers should contact:
For BlueChoice and BlueChoice Solutions members – Magellan Behavioral Health, Inc. (800) 528-7264

For HMO Blue Texas members – Magellan Behavioral Health Providers of Texas, Inc. (800) 729-2422

Provider Newsletter

Blue Review

Blue Review is an information resource that keeps you and your staff informed of important policy changes, new procedures, claims practices and legislative changes.  Current and archived editions of Blue Review are available at Blue Review Archive.

Other Blue INFO to Know

BlueChoice Solutions Network
BlueCompare for Physicians
Explore Your Paperless Possibilities at BCBSTX

Time to Join

We welcome you to join the others who have discovered the distinction in being a BCBSTX contracted network provider. After all, we're the trusted, recognized brand in health care with:

• The only statewide not-for-profit plan 
• One of the largest PPO networks in the state 
• Innovative programs to control health care costs 
• A strong commitment to Texas since 1929—born and based here 

There's no better time than now to be Blue!

Time for You

At BCBSTX, we make it our mission to provide you with ongoing support and the updated information you need. You not only get assistance from your PPND Representative and local network office, but also have easy access to the following internet resources.  Just to name a few...

• Reimbursement information
• Medical policies
• Bundling information (Clear Claim Connection)
• Claim appeal/reconsideration review process
• Refund & Recoupment information
• Provider Finder®  (online provider directories include NPI numbers)
• Provider manuals
• Reference guides
• Downloadable forms
• Specialty Drug Program
• iEXCHANGE for referrals and inpatient precertifications to acute care facilities
• Radiology Quality Initiative Program (AIM)
• Electronic Commerce – Availity, RealMed & eCare/NDAS/Nebo
• National Provider Identifier (NPI)
• Claim Pointers
• Fraud Awareness Program
• Wellness Guidelines
• Online Provider Orientation
• Provider Newsletter – Blue Review
• Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA) & Electronic Provider Summary (EPS) Enrollment

or go to : www.bcbstx.com/provider to view all of the resources located on the BCBSTX Provider Web site

Time for Your Community

BCBSTX is committed to enhancing health care in your community through:

• Wellness Initiatives/Programs offered through employer groups (Tobacco Cessation, Weight Management & Worksite Wellness)
• Building Healthy Families initiative
• Caring for Children Foundation of Texas
• Care Van® Program for children's immunizations
• Support of more than 150 community-based charitable organizations through time, effort and funding

revised 11/2009