Print

BlueChoice® Online Orientation Check List

  1. BlueChoice Physician and Other Professional Provider — Provider Manual — under the Standards and Requirements tab, go to the General Reimbursement Information area and click on View General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the BlueChoice Physician and Other Professional Provider - Provider Manual.
    • PPO/POS plans (Section B)
    • Physician and other Professional Provider Roles and Responsibilities (Section B)
    • Referrals Required for POS Plan Only (Section B)
    • Sample ID Cards  (Section B)
    • Filing Claims (Section F)
    • Provider Customer Service — 800-451-0287
  2. BlueChoice Quick Reference Guides — under the Education and Reference tab, go to the Related Links area, click on Reference Guides, then click on the offering Product and Group Reference Guides 
  3. iEXCHANGE — Preauthorization and Online Approval of Benefits for Selected Outpatient Services and Inpatient Admissions
  4. Laboratory Services — Go to the Standards and Requirements tab, then go to the General Reimbursement Information area and click on View General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the BlueChoice Physician and Other Professional Provider - Provider Manual, then select Section B.
    • Quest Diagnostics, Inc. is the preferred statewide outpatient clinical reference laboratory for BlueChoice.
  5. Radiology Services — Go to the Standards and Requirements tab, then go to the General Reimbursement Information area and click on View General Reimbursement Information, (password protected-enter password), then under Manuals, click on View Manuals and then select the BlueChoice Physician and Other Professional Provider - Provider Manual, then select Section B or click on Radiology Services to access the information on the website.
    AIM Specialty Health (AIM®'):
    • A Radiology Quality Initiative (RQI) number is required on certain outpatient procedures for BlueChoice subscribers.
    • The following High tech outpatient diagnostic radiology procedures require a RQI number: CT/CTA scans, MRI/MRA scans, SPECT/Nuclear Cardiology studies and PET scans (excludes radiology services provided during emergency room visits, in-patient admissions, out-patient surgeries and 23 hour observation).
    • To obtain the RQI number, just log onto AIM's Provider Portal  and complete the online questionnaire that identifies the reasons for requesting the exam or contact American Imaging Management (AIM) at 800-859-5299.
      Note: Requests for these procedures cannot be processed in the iEXCHANGE System.
    • View the CPT Codes  affected by this program.
  6. Filing Claims — Go to the Standards and Requirements tab, then go to the General Reimbursement Information area and click on View General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the BlueChoice Physician and Other Professional Provider - Provider Manual, then select Section F.
  7. Filing Claims — For OBGyn Physicians
  8. Pharmacy — Specialty Drug Programs
  9. BlueChoice Provider Directory
    • Go to the Network Participation tab, then go to the Provider Finder offering
  10. Changes Affecting Your Provider Record ID, Change in Your Status or Changes Affecting Your NPI Number, Added a New Office Location, Moved to a New Office Location?

    Call 972-996-9610, press 3 or go to the Network Participation tab, then go to the Update Your Contact Information offering, complete and submit the online form or print and fax it to the indicated number.

  11. BCBSTX's Wellness Initiatives/ Programs
  12. Review of the BCBSTX Provider Website
    • Home Page
      • Electronic Commerce
      • AvailityiEXCHANGE
      • Blue Medicare Advantage
      • Medicare (STAR) and CHIP
      • Medical Policies
    • Network Participation
      • How to Join BCBSTX Provider Networks
      • Update Your Information
      • Provider Finder
      • Consent to Assignment of Provider Contracts (Change of Ownership – CHOW) for Facility/Ancillary
    • Claims and Eligibility
      • BlueCard Program
      • Claim Review Process
      • Electronic Commerce
      • How to Check Claim Status
      • Medicare Advantage Private Fee-for-Service
      • Physicians' Advisory Committee (PAC)
      • BlueCard Program Claim Filing
    • Education and Reference Center
      • Forms
      • Manuals
      • News and Updates
      • Provider Tools
      • Training
    • Clinical Resources
      • Behavioral Health
      • Clinical Practice Guidelines (CPGs)
      • Clotting Factor Product Initiative
      • e-Cards for Health
      • iEXCHANGE – Automated Preauthorization and Referral System
      • Maternity Program: A Healthy Start for Mother and Baby
      • Pre-cert/Pre-auth Router (for out-of-area members)
      • Radiology Quality Initiative/Preauth Program
      • Wellness Guidelines
      • Wellness Initiatives/Programs
    • Pharmacy Program
      • Digitek Recall
      • Dispensing (Quantity vs. Time) Limits
      • Medicare Part D Pharmacy Updates
      • Medicine Safety Project
      • IVIG Drug Program
      • Preferred Drug Guide
      • Rx List and Prescribing Guidelines
      • Specialty Drug Programs
      • Step Therapy/Prior Authorization
      • Synagis and RSV
      • Topical Verapamil
    • Standards and Requirements
      • ANSI 5010
      • Disclosure Notices
      • Draft Medical Policies
      • General Reimbursement Information
      • ICD-10
      • Medical Policies
      • Medical Policy and Pre-certification/Pre-authorization Router for Out-of-Area members
  13. Review of the Secured Area of the BCBSTX Provider Website (password protected-enter password)
    • Manuals
    • Medical Policy Request Form
    • Preauthorization/Notification/Referral Requirements Lists
    • Recoupments and Refunds
    • Reimbursement Schedules and Related Information
    • Bundling Information
    • All Product News
    • HMO Blue Texas - Outpatient Clinical Reference Lab Services
    • Member Liability Estimate
    • Cost Estimator Tool

Revised 03/06/2013