Patient Cost Estimator (Member Liability Tool)
The Availity® Patient Cost Estimator (PCE) tool is an online member liability estimator that can help professional and institutional providers estimate a patient’s potential out-of-pocket costs in real-time for office, inpatient and outpatient services provided to BCBSTX members.
The PCE is available free of charge to BCBSTX independently contracted and out of network providers who are registered with Availity.
How does the PCE determine an estimate?
- It analyzes the patient’s primary diagnosis, procedures performed, available benefits and contractual allowances to calculate an estimate based on the information available at the time the estimate was processed.
- Actual coverage and member liability amounts are determined when the claim is processed.
The PCE allows your office the option of collecting the member’s share at the point of service. You may not collect an amount greater than the amount listed by the PCE at the time services are rendered. Any overpayments must be refunded to the member within 30 days.
For more details, refer to the Availity Patient Cost Estimator User Guide .*
Please note: Benefits will be determined once a claim is received by BCBSTX and will be based upon, among other things, the member’s eligibility, benefits, limitations and exclusions and the terms of the member’s certificate of coverage in effect on the date services are rendered.
*See the User Guide for a brief list of exceptions.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.