Health Care Provider Forms

General

Electronic Payment Solutions

Form

Description

Availity.com

Save time and enroll online for Electronic Funds Transfer and Electronic Remittance Advice.
Learn more.

Medical Policy Forms (Note: May be used as a supplement to medical record documentation)

Behavioral Health/Mental Health Forms for ERS Participants

Form

Description

Mental Health Forms for Employee Retirement System of Texas (ERS)

Select Link for list of forms

Behavioral Health Forms for TRS Participants

Form

Description

Behavioral Health Forms for Teacher Retirement System of Texas (TRS)

Select Link for list of forms

Behavioral Health for Other BCBSTX Plans

(Note: for ERS or TRS participants refer to specific form links above)

Pharmacy

Form

Description

Express Scripts® Pharmacy Mail Order: ePrescribe new prescriptions to EXPRESS SCRIPTS HOME DELIVERY or call 888-327-9791 for faxing instructions

Fax forms must be faxed from a physician's office

Accredo Specialty Pharmacy General Use Fax Form

Specialty pharmacy drugs fax form for general use

Accredo Specialty Pharmacy Referral Forms by Therapy

Specialty pharmacy drugs fax form by drug therapy

Quantity Limit Override Request

Request to override the dispensing/quantity limit

Topical Verapamil Override Request