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HMO Blue® Texas Online Orientation Check List

  1. HMO Blue Texas Physician and Other Professional Provider — Provider Manual — under the Standards and Requirements tab, go to General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the HMO Blue Texas Physician and Other Professional Provider — Provider Manual.
    • Limited Provider Networks — if applicable (Section A)
    • HMO Blue Texas ID Card (Section B) and link to Sample of "Standard" HMO Blue Texas ID Card 
    • PORG - location on ID Card
    • Physician and other Professional Provider Roles and Responsibilities (Section B)
    • Referrals Required (Section B)
    • Filing Claims (Section F)
    • Provider Customer Service — 877-299-2377
  2. HMO Blue Texas Quick Reference Guide (QRG) — under the Education and Reference tab, go to the Related Resources area, click on Reference Guides, then click on Product and Group Specific Reference Guides, and finally, click on the offering HMO Blue Texas Quick Reference Guide 
    • Review each column of the Quick Reference Guide:
      • Major Characteristics
      • Benefits, Eligibility, Claims Status and Verification
      • Correspondence, Claim Review Process
      • Preauthorization/Notification/Referral Requirements — under the Standards and Requirements tab, go to General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the HMO Blue Texas Preauthorization/Notification/Referral Requirements List
      • Laboratory and Radiology Services
      • Behavioral Health
  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 General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the HMO Blue Texas Physician and Other Professional Provider — Provider Manual, then select Section B.
    • Quest Diagnostics, Inc. is the exclusive outpatient clinical reference laboratory for HMO Blue Texas.
    • Reimbursable Lab Services List — if performed in physician's office
  5. Radiology Services — Go to the Standards and Requirements tab, then go to General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the HMO Blue Texas 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®') — precertification is required for the following High tech outpatient diagnostic radiology procedures: CT/CTA scans, MRI/MRA scans, SPECT/Nuclear Cardiology studies and PET scans (excludes radiology services provided during emergency room visits, inpatient admissions, outpatient surgeries and 23 hour observation).
    • For precertification, 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 General Reimbursement Information (password protected-enter password), then under Manuals, click on View Manuals and then select the HMO Blue Texas Physician and Other Professional Provider — Provider Manual, then select Section F.
  7. Filing Claims — For OBGyn Physicians
  8. Pharmacy — Specialty Pharmacy Programs
    • Go to the Pharmacy Program tab, then go to the "Prime Specialty Pharmacy " offering
  9. HMO Blue Texas 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. Review of the BCBSTX Provider Website
    • Home Page
      • Electronic Commerce
      • Availity/iEXCHANGE
      • Blue Medicare Advantage
      • Medicaid (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 Filing Tips
      • Claims Review Process
      • Electronic Commerce
      • How to Check Claim Status
      • Medicare Advantage Private Fee-for-Service Router
      • Physicians’ Advisory Committee (PAC)
    • 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
      • 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
  12. 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