Additional Benefit Categories Contained in IVR Phone System

May 22, 2017

Our May 2017 Blue Review included a list of the common benefit categories contained within the Blue Cross and Blue Shield of Texas (BCBSTX) Interactive Voice Response (IVR) phone system. Beginning June 19, 2017, the list will be expanded to include additional common benefit categories. The IVR quotes the same level of eligibility and benefit information as a Customer Advocate provides. Our Customer Advocates will continue to be available for more complex benefit quotes.

To help ensure provider readiness, an updated IVR benefit containment list is included below. This list outlines those categories that were effective starting on Dec. 12, 2016, along with the additional categories to be implemented June 19, 2017. As a reminder, this information is continually reviewed and may vary across different BCBSTX networks, products and/or group policies. There are no other benefit categories being added to the Federal Employee Program (FEP) IVR-Contained Benefits list at this time. To view the separate containment list for FEP members, refer to the article in the May 2017 Blue Review.

Note: These listings are not applicable to Blue Cross Medicare Advantage(PPO)SM or Blue Cross Medicare Advantage (HMO)SM government program member policies. For eligibility and benefits for these government programs refer to the number on the member's BCBSTX identification card.

IVR-Contained Benefit Categories Effective Dec. 12, 2016 Additional IVR-Contained Benefit Categories Effective June 19, 2017
  • Allergy
  • Colonoscopy
  • Consultations
  • Coordinated Home Care
  • Electrocardiogram (EKG)
  • Extended Care Facility
  • Hospital
  • Inhalation Therapy
  • Laboratory
  • Mammogram
  • Office Services
  • Office Visit
  • Pap Smear
  • Physical Exam
  • Preventive Care
  • Private Duty Nursing
  • Ultrasound
  • X-ray
  • 23-hour Observation
  • Air Ambulance
  • Anesthesia
  • Assistant Surgeon
  • CAT Scan
  • Dialysis
  • Ground Ambulance
  • Hospice
  • Medical Supplies
  • MRI
  • Pathology
  • PET Scan
  • Prosthetics
  • Prostate-specific Antigen (PSA)
  • Sterilization

As a reminder, checking eligibility and benefits electronically through AvailityTM or your preferred Web vendor is the quickest way to access information for BCBSTX members. To learn more about online solutions, refer to the Education and Reference Center/Provider Tools section of our website at

Checking 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 and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have questions, please call the number on the member's ID card.

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. 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.

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