Claim Submission
This section provides a quick introduction to filing claims with Blue Cross and Blue Shield of Texas. For more information, such as timely filing requirements, coordination of benefits, Medicare crossover process details and more, please refer to the provider manuals.
Electronic Claims
You or your billing agent will need to use a third-party claims clearinghouse vendor such as Availity® Essentials to submit electronic professional and institutional claims (ANSI 837P and 837I transactions) to BCBSTX. For vendor options and information, refer to electronic commerce.
- Advantages include greater security and accuracy of data, along with faster processing and payment.
- Claims may be submitted one at a time by entering information directly into an online claim form on the vendor portal; or batch claims may be submitted via your practice management system (check with your software vendor to ensure compatibility).
- Electronic reports are generated and sent automatically to confirm receipt and identify any errors that need to be rectified prior to adjudication and payment.
Paper Claims
Please refer to the following websites for assistance with proper completion of paper claim forms:
- For CMS-1500 (professional) claims, visit National Uniform Claim Committee
- For UB-04 (institutional) claims, visit National Uniform Billing Committee
Commercial Claims
Electronic claim submission is preferred. If necessary, commercial paper claims may be submitted to this address:
BCBSTX
PO Box 660603
Dallas, TX 75266-0603
Government Program Claims
For government program claims, if you do not have online access, you may call provider customer service to check claim status or make an adjustment.
- Blue Cross Medicare AdvantageSM — 1-877-774-8592
- Texas STAR, CHIP — 1-877-560-8055
- STAR Kids — 1-877-784-6802
Additional Reminders
- Don’t submit duplicate claims.
- To confirm receipt and adjudication progress, check claim status.
Out-of-Area (BlueCard®) Claim Process
BlueCard is a national program that enables members of one Blue Cross and Blue Shield Plan to obtain health care services while traveling or living in another BCBS Plan’s service area.
- The program allows you to submit claims for members from other BCBS Plans to BCBSTX.
- The three-character prefix preceding the member’s ID number is critical for proper routing of BlueCard claims.
- For complete details, refer to the BlueCard Program Manual.
Documentation and Coding Resources
High-quality documentation and complete, accurate coding can help capture our members’ health status and promote continuity of care. We’ve put together some documentation and coding tip sheets for the following conditions:
- Asthma and Asthma-Associated Conditions
- Atrial Fibrillation
- Cancer and Cancer-Related Treatments
- Chronic Kidney Disease
- Diabetes Mellitus
- Human Papillomavirus
- Hypertension (High Blood Pressure)
- Major Depressive Disorder
- Medicare Annual Health Assessments
- Medication Reconciliation Post-Discharge
- Mental, Behavioral and Neurodevelopmental Disorders
- Obesity and Morbid Obesity
- Vascular Disease
Related Resources
- Claims IVR Caller Guide
- Electronic Replacement/Corrected Claim Submissions
- Billing with National Drug Codes Frequently Asked Questions
- NDC Billing Guidelines
- ICD-10-CM Z Codes for Social Determinants of Health
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 Blue Cross and Blue Shield of Texas. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.