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Eligibility and Benefits

Blue Cross and Blue Shield of Texas (BCBSTX) patient eligibility and benefits should be verified before every scheduled appointment. Eligibility and benefit quotes include membership verification, coverage status, preauthorization requirements and determination that the provider is in-network for the patient’s policy. It also includes other important information, such as applicable copayment, coinsurance and deductible amounts. It’s strongly recommended that providers ask to see the member’s ID card for current information and photo ID to guard against medical identity theft. When services may not be covered, members should be notified that they may be billed directly.

Checking Online

Providers are strongly encouraged to use the Availity® Provider Portal Learn more about third-party links or their preferred vendor for eligibility and benefit verifications. With Availity’s Eligibility and Benefits Inquiry, users can access printable results that include up to date benefit information.

  • Patient/Subscriber information
  • Group Number
  • Group Name
  • Plan/Product
  • Current Effective Dates*
  • Copayment*
  • Deductible (original and remaining amounts)
  • Out-of-pocket (original and remaining amounts)
  • Coinsurance
  • Limitations/Maximums*
  • Preauthorization Indicators and Contacts

For some patients, your web transactions may instruct you to call Provider Customer Service to obtain benefit details. Our staff remains available to assist with these benefit inquiries as needed.

* These benefit categories will only appear if applicable to the services being rendered.

Be sure to check out the Availity Eligibility and Benefits Tip Sheets in Related Resources in the right hand column.

You must be registered with Availity  to gain access to the Eligibility and Benefits Inquiry and other online resources offered by Availity.

Checking via Telephone

For most BCBSTX members, if you cannot submit your eligibility and benefit inquiries online, this information can also be easily obtained through our Interactive Voice Response (IVR) automated phone system at 800-451-0287, available Monday through Friday, 6 a.m. to 11:30 p.m., CST, and Saturday, 6 a.m. to 6 p.m., CST.

Exceptions

For government programs member information, the provider customer service phone numbers are as follows:

  • Blue Cross Medicare AdvantageSM1-877-774-8592
  • Texas STAR, CHIP – 1-877-560-8055
  • STAR Kids – 1-877-784-6802

For out-of-state Blue Cross and Blue Shield members, call BlueCard® Eligibility at 1-800-676-BLUE (2583) for eligibility and benefit verifications.  Learn more about BlueCard

For Federal Employee Program (FEP) members, eligibility and benefits can be obtained by calling 1-800-442-4607.

Training

Online training sessions - Learn More

Questions

Email our Provider Education Consultants. Be sure to include your name, direct contact information, tax ID or billing NPI.

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.

Availity is a trademark of Availity, L.L.C., 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 offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.