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Availity® Essentials
Register with Availity at no cost to conduct secure online transactions, such as checking eligibility and benefits, submitting prior authorization requests handled by Blue Cross and Blue Shield of Illinois, obtaining claim status, viewing provider claim summaries and more. Availity Essentials – See the payer space for Blue Cross and Blue Shield of Texas
If you aren’t yet registered for Availity Essentials, sign up at no cost.
Payer ID: 84980To learn more about Availity tools, refer to our Provider Tools page.
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Behavioral health program
For prior authorization, recommended clinical review and referrals managed by BCBSTX:
Call 800-528-7264 or the phone number listed on the member ID card.
Learn more about our behavioral health program.
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BlueCard Eligibility® Line
Call for out-of-state Blue Cross and Blue Shield member eligibility and benefits 800-676-2583
Learn more on our BlueCard page.
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Blue Cross and Blue Shield of Texas
1001 E. Lookout Drive
Richardson, TX 75082
800-451-0287 -
Carelon medical benefits management
Carelon Provider Portal (available 24x7)
Carelon Contact Center: 800-859-5299
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Care management programs
855-462-1781
Administrative services only, fully insured or regulated small group: 800-462-3275
Individual and Family: 888-697-0683
Federal Employee Program: 866-412-8795
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Claims and payment – Medicaid
Electronic medical claim submission BCBSTX Electronic Payer ID: 66002 Eligibility, benefit information, claims status or verification Availity Essentials or a web vendor of your choice
877-560-8055 – STAR/CHIP
877-784-6802 – STAR KidsPaper medical claim submission Blue Cross and Blue Shield of Texas
PO Box 650712
Dallas, TX 75265-0712Medical appeals and complaints Mailing address (appeals):
Blue Cross and Blue Shield of Texas Attn: Complaints and Appeals Department
P.O. Box 660717
Dallas, TX 75266-0717Fax (appeals): 855-235-1055
Email
Appeal form: Provider Appeal Request Form -
Federal Employee Program®
Verify eligibility and benefits and/or check claim status for FEP® members EHB: 800-442-4607
PSHB: 877-707-2786
FEP® behavioral health services: 800-528-7264
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Fee schedule requests (professional)
View fee schedule forms and instructions.
For details on self-service options, refer to the Fee Schedule via Availity page.
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Fraud reporting
Report concerns of potential fraud 24x7, online or by phone. All inquiries to our Special Investigations Department are confidential, and you may remain anonymous. Online: File a report
Fraud Hotline: 800-543-0867
U.S. Mail:
Blue Cross and Blue Shield of Texas
Special Investigations Department
300 E. Randolph St., 35th floor
Chicago, IL 60601 -
Medicaid
Refer to BCBSTX Medicaid website and Contact Us page.
Medicaid Network Management: Email to submit provider inquiries and questions
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Medicare Advantage
Medicare Advantage Provider Customer Service
Individual plan phone 877-774-8592 Group plan phone 877-299-1008 Medicare Advantage Claims Payments and Appeals
Electronic claims (preferred) Availity® Essentials or your preferred vendor
Electronic payer ID 66006
Paper claims Blue Cross Medicare Advantage
c/o Provider Services
PO Box 3686
Scranton, PA 18505Medicare Advantage Claims Payments and Appeals
Register with Availity at no cost to conduct secure online transactions, such as checking eligibility and benefits, submitting prior authorization requests handled by Blue Cross and Blue Shield of Illinois, obtaining claim status, viewing provider claim summaries and more. Learn more, register or log on: Availity Essentials
Availity Client Services: 800-282-4548
Prospective and Concurrent Medical Appeals
Who can request a medical appeal: Member, member's authorized representative, contracted providers or noncontracted providers
Standard appeals fax 1-800-419-2009 Expedited appeals fax 1-800-338-2227 Mailing address Blue Cross Medicare Advantage
c/o Appeals Department
PO Box 663099
Dallas, TX 7526Retrospective Medical Appeals
Who can request a retrospective medical appeal: Member, member's authorized representative or noncontracted providers
Standard appeals fax 1-800-419-2009 Mailing address Blue Cross Medicare Advantage
c/o Appeals Department
PO Box 663099
Dallas, TX 75266Provider Disputes
Who can request a provider dispute: contracted providers
Standard claims dispute fax 1-855-674-9192 Mailing address
Blue Cross Medicare Advantage
c/o Provider Disputes
PO Box 4555
Scranton, PA 18505Provider Claims Disputes
Who can request a provider claims dispute: Contracted and noncontracted providers
Standard claims dispute fax 1-855-674-9192 Mailing address Blue Cross Medicare Advantage
Attn: Provider Claims Disputes
PO Box 4555
Scranton, PA 18505Grievances
Who can file a grievance: Member or member’s authorized representative
Grievance fax 1-855-674-9189availity- Mailing address Blue Cross Medicare Advantage
Attn: Grievances
PO Box 4288
Scranton, PA 18505Medicare Advantage Utilization Management
Availity Authorizations & Referrals Electronically submit prior authorization requests
Prior authorization requirements for Medicare Advantage EviCore healthcare prior authorization Prior authorization and out-of-network referrals Phone: 877-774-8592
Fax: 855-874-4711 -
Provider customer service
Provider customer service - commercial 800-972-8088 (Monday through Friday, 8 a.m. to 11:30 p.m. CT; and Saturday, 6 a.m. to 3:30 p.m. CT) Provider customer service - Medicaid 877-560-8055 – STAR/CHIP
877-784-6802 – STAR Kids
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Provider directory - Medicaid
Online Provider Finder® or provider status (To verify a provider’s status, access the online provider directory) Online provider directory:
Provider Finder -
Provider relations representatives - Ancillary
Ambulance Ambulatory surgery centers – Independent, non-hospital owned Behavioral health facilities only
- Inpatient psychiatric and detox facilities
- Residential treatment centers – Psychiatric and substance abuse
- Partial hospital programs
- Intensive outpatient facility programs
Birthing centers Catheterization center Phone: 713-354-7033
Diabetic management Disease management Durable medical equipment Freestanding emergency rooms Hearing aid supplier Home health Home health dialysis Home infusion therapy Hospice Imaging Independent clinical / specialty labs Independent diagnostic testing facility
If provider’s primary specialty is imaging, lab or sleep lab, refer to that specialty in this contact list.
Long-term acute care hospital Physical rehabilitation facilities – Inpatient Postacute brain injury facilities Prosthetics/orthotics Radiation therapy center Renal dialysis Skilled nursing facility Sleep studies centers -
Provider relations representatives - Facility and group
Abilene
Amarillo
Lubbock
Midland
San Angelo
North Texas
East Texas1001 E Lookout Drive
Richardson, TX 75082-4144
361-878-1623Austin and Central TX Arboretum Plaza II
9442 Capital of Texas Hwy N, Suite 500
Austin, TX 78759-7228
800-336-5696
512-349-4847Corpus Christi and The Valley 4444 Corona, Suite 148
Corpus Christi, TX 78411-4375
361-878-1623El Paso 114 Mesa Park Dr. Suite #300
El Paso, TX 79912-6156
915-496-6600, press 2
Email to submit provider inquiries and questionsHouston 8101 W. Sam Houston Parkway South
Houston, TX 77072
800-637-0171, press 3
713-663-1149San Antonio and Laredo 17806 IH 10 West, Bldg II, Suite 200
San Antonio, TX 78257-8222
361-878-1623
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.
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. Carelon Medical Benefits Management is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products or services they offer.