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:

Step 1 - 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).

Special Note:  Requesting a provider record from BCBSTX does not mean you are a participating provider in the BlueChoice® or HMO Blue® Texas provider network - you must complete the application process described below and be accepted.

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

Note: To add a provider to an existing group, use the Group Member Information Form on page 4.

Step 2 - Once you have a record set-up with BCBSTX, and if you are one of the following provider types we contract with, then complete the Texas Standardized Credentialing Application and all applicable attachments.  (CAQH Users, please contact CAQH for instructions in downloading your information to the TDI Credentialing application.) 

• 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

Additionally, you must complete our BCBSTX Cover Page, which needs to be submitted in conjunction with the credentialing application. Use the TDI Credentialing Application Completion Guide to verify that you are submitting a fully completed application. Incomplete applications will be returned.

If you are a Behavioral Health Professional, the Behavioral Health Form must be completed and returned along with the application and cover page.

Step 3 - After completing all the required information stated above, complete the online request form to request for a contract be sent to you from BCBSTX, or contact your local Professional Provider Network office. 

Local Professional Provider Network Department (PPND) Offices:

Step 4 - Review the provider agreements to fully understand your requirements for participation such as referrals to in-network facility/providers and other administrative services.

Step 5 - Submit your fully completed application, cover page and agreement(s)/contract(s) to your local PPND office.

Note: Before mailing your completed application packet to your local Professional Provider Network office, make sure the following completed documents are enclosed:

• TDI Standardized Application (pages 1-20) & all applicable attachments
• BCBSTX Cover Page
• Behavioral Health Form (if applicable)
• Signed Agreement(s)/Contract(s)

The Credentialing Process

Your completed Texas Standardized Credentialing Application, Texas Department of Insurance (TDI) form LHL234, and network agreement(s)/contract(s) will be processed and finalized within 180 days. The BCBSTX credentialing committee will notify you in writing of the decision, or you may also contact your local PPND office. Once approved, your PPND Representative will contact you to schedule an orientation at your convenience.

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 Certification & 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, click here.

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 professisonal provider's office or other outpatient setting:

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

For additional information on the AIM program, click here.

Injectable Drug Program
McKesson Specialty Pharmaceuticals
(800) 239-3249

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

For additional information on the Injectable Drug Program, click here.

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
INROADS® Behavioral Health Services  
(800) 528-7264

INROADS coordinates behavioral health services for BlueChoice and BlueChoice Solutions members.
For HMO Blue Texas members, physicians and other professional providers should contact Magellan Behavioral Health directly at (800) 729-2422.

Provider Newsletter

Blue Review

Blue Review is a quarterly 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

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
• Preferred drug list
• Injectable Drug Program
• iEXCHANGE for referrals and inpatient certifications
• Radiology Quality Initiative Program (AIM)
• Electronic Commerce – Availity
• National Provider Identifier (NPI)
• Claim Pointers
• Fraud Awareness Program
• Wellness Guidelines
• Online Provider Orientation
• Provider Newsletter – Blue Review

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 9-2008