How to Correctly Use Our Claim Review Form


Blue Cross and Blue Shield of Texas (BCBSTX) has revised our Claim Review Form. This form is available on the provider website under Education and Reference/Forms.

Below are reminders for how to correctly use the Claim Review form.

When to use the Claim Review Form:

  • This form is only to be used for review of a previously adjudicated claim
  • Original claims should not be attached when submitting this form

When Not to Use the Claim Review Form:

  • Do not use this form to appeal on behalf of a member
  •  Do not use this form to submit a corrected claim or respond to a request for additional information. Refer to separate forms for these submissions on our Forms page on the website.  

Other Reminders:

  • Inquiries without the required information (denoted by an *asterisk on the form) may not be reviewed
  • You must include the completed form, even when submitting your inquiry electronically

Learn More

Review information on the Claim Form and refer to the Texas Provider Manuals for more information and detail on claim reconsiderations and how to use the Claim Review form.