Medicare Advantage – Electronic Claim Rejection Alert

Effective immediately, Medicare Advantage claims transmitted electronically to Blue Cross and Blue Shield of Texas (BCBSTX) will be rejected. Submitters will receive a three digit/alpha error code with a message on the response report(s) as follows:

4EM>Claim must be submitted to payer "TXPPO."

This applies to Professional and Institutional electronic claims. Medicare Advantage members may be easily identified by the ZGD alpha prefix at the beginning of their BCBSTX member ID number.

If you utilize a billing agent and/or a clearinghouse, please ensure that they are aware and responsive to this and other messages specified on the response report(s) you currently receive.

Any questions regarding this notification may be directed to our Electronic Commerce Center at (800) 746-4614.