This link will take you to a new site not affiliated with BCBSTX. It will open in a new window.
To return to our Web site, simply close the new window. Refer to important information for our linking policy.
Private Pay Agreement
Request for Prior Authorization – Acute
Request for Prior Authorization – Long Term Services and Support (LTSS)
LTSS Authorization Request Checklist
Texas Standard Prior Authorization of Health Care Services Form
Access Appointment Availability OBGYN
Access Appointment Availability PCP
Access Appointment Availability Specialist
Claim Status Request Form
DME Request for Claim Status Form
DME Review Request Form
Migrant Farmworker Questionnaire
Outreach Request Form
Provider Appeal Request Form
Provider Refund Form
Rate Enhancement for Attendant Compensation Form
Reconsideration Request Form
Sports and Camp Physical Reimbursement Form
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
© Copyright 2018 Health Care Service Corporation. All Rights Reserved.