Update: Texas Severe Weather: BCBSTX Responds to Help Providers

September 18, 2017

Many Blue Cross and Blue Shield of Texas (BCBSTX) providers and members are currently being impacted by Hurricane Harvey. Members and Providers who are residents of the 60 disaster counties or those impacted by Harvey will be covered by Governor Greg Abbott's proclamation. Recovering from a natural disaster like Hurricane Harvey is never easy. Throughout the duration of the governor’s proclamation, we are helping members by:

  • Authorizing up to a 90-day supply of prescription medications for members
  • Not requiring pre-authorization or referrals (members' benefit coverage will apply)
  • Allowing claims for an HMO member to receive services out-of-network if necessary, without a referral
  • Extending claim filing deadlines for providers
  • Work with members to extend premium payment deadlines
  • Authorize payment for necessary medical equipment, supplies, and services regardless of the date on which the service, equipment, or supplies were most recently provided

How to Check Eligibility:

Checking eligibility, benefits and accessing patient clinical summaries electronically through AvailityTM or your preferred web vendor is the quickest way to access BCBSTX member information. To learn more about online solutions, see the Provider Tools section on the BCBSTX Provider website. Additionally, we are providing a list of important phone numbers you can use to verify eligibility and benefits if you do not have internet access:

  • Blue Advantage HMOSM:
    • Provider Customer Service - 800-451-0287
    • Utilization Management - 855-896-2701
  • Blue EssentialsSM:
    • Provider Customer Service - 877-299-2377
    • Utilization Management - 855-896-2701
  • PPO (Blue ChoiceSM and Home Blue Card members):
    • Provider Customer Service - 800-451-0287
    • Utilization Management - 800-441-9188
  • Medicare Advantage HMO & PPO:
    • Provider Customer Service - 877-774-8592
    • Utilization Management - 877-774-8592
  • Blue PremierSM
    • Provider Customer Service - 800-676-2583
    • Utilization Management - 800-441-9188
  • STAR Kids - 1-877-784-6802
  • CHIP and STAR - 1-877-560-8055

Note: Adoption Assistance and Permanency Care Assistance (AAPCA) eligibility and benefits should be verified using the STAR and STAR Kids information above.

  • Medicaid Personal Care attendants see additional information for Electronic Visit Verification (EVV) below.
  • National BlueCard® access (Host Blue Card members): 800-676-BLUE (2583)

Claims and Provider Reimbursement Payments

Be sure to include your NPI on all claims to ensure accurate and timely claim processing. Please remind your office staff to bill BCBSTX directly for all services rendered to patients with BCBSTX coverage. We will then compensate you based on each specific patient’s (member) benefits. Your Provider Claims Register will indicate any patient responsibility for payment, and you may bill your patient for that amount. If you are providing care outside of your home office location, please continue to use the address to your permanent location. If you have online access, please use the Availity® provider portal at Learn more about third-party links which provides access to member’s real-time eligibility & benefits and claims status information, as well as offers batch or web claim submissions.

Your provider reimbursement payments will continue to be processed as claims are submitted. If you are receiving a paper check payment, service should resume in accordance with the United States Postal schedule. If you need a payment prior to that time or have any other payment related inquiries, please call customer service.

Need Prior/Preauthorization/Extension/Clinical Care:

  • BCBSTX's prior authorization unit has extended hours from 8 a.m. to 8 p.m. until further notice.
  • BCBSTX will review requests as per our normal business operation and manage issues on a case by case basis to ensure that our members have access to the necessary care they need during this time. However, if your patients don't have their ID card, they should call member services or print a temporary card from Blue Access for MembersSM.
    Note: Medicare Advantage patients should call member services if they don't have their ID card.
  • Magellan can be reached at 800-729-2422.
    Note: Magellan is providing free, confidential counseling services and other resources, such as referrals to local non-profit organizations, shelters and additional community-based support. Onsite counseling services are available for a small fee. The toll-free number to access free, confidential counseling services is 1-800-327-7451.
  • eviCore can be reached at 855-252-1117 or by visiting Learn more about third-party links.
  • Quest Diagnostics, Inc. - For locations or questions, contact Quest at 888-277-8772 or visit Quest's website at: Learn more about third-party links.
  • Clinical Pathology Laboratory (CPL) – For locations or questions, contact CPL at 800-595-1275 or visit CPL's website at: Learn more about third-party links.

* Checking eligibility, benefit information and/or if a service has been preauthorized 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 any questions, please call the number on the back of the member's ID card.

Provider Service Hours:

For phone inquiries and requests:
(Monday – Friday) 6 a.m. – 6 p.m.
(Saturday – Sunday) 9 a.m. – 6 p.m.

Pharmacy Provider:

Pharmacy customer service will remain open for 24 hours. In addition, our customer advocates are providing customized assistance to members in the impacted zip codes.

Helpful Tips to Relay to Your Patients:

  • For emergencies, your patients should call 911 or go directly to the nearest hospital.
  • For non-emergencies, your patients should call member services to find a doctor or health care professional in their network.
  • Your patients should bring their BCBSTX member ID card when they get care.
  • However, if your patients don't have their ID card, they should call member services or print a temporary card from Blue Access for Members. Note: Medicare Advantage patients should call member services if they don't have their ID card.
  • If your members have questions, please direct them to for updates.

Medicaid Provider Information:

Electronic Visit Verification (EVV) for Personal Care attendants:

  • Providers that are unable to call in and/or call out because of Hurricane Harvey will need to complete visit maintenance for those visits using Reason Code 130; Disaster or Emergency to document service delivery in the EVV system.
  • Reason Code 130 is used when an attendant or assigned staff is unable to provide all or part of the scheduled services due to a disaster (e.g. Flood, tornado, ice storm, fire, etc.) or other emergency (e.g., EMS must be called). Reason Code 130 is a preferred reason code.
  • Free text is required in the comment field; the provider must document the nature of the disaster or emergency and the actual time service delivery begins and/or ends in the comment field. For example: Hurricane Harvey. Time in: 8:30 am - Time out: 11:30 am.
  • EVV Providers: If phone service is interrupted or unavailable during service delivery, attendants should document:
    • Service start and end times
    • Small Alternative Device (SAD) values

This documentation is necessary to ensure service visits can be verified in the EVV system once phone service is restored.

Pharmacy for Medicaid Members

  • BCBSTX is implementing a dynamic PA (dPA) for their Medicaid members for refill too soon rejections at the pharmacy. The dynamic PA will be in place for 7 days, implemented as of 8/24, and allow a 30-day refill of the members' medications. In addition, our PBM will provide a report for medications filled through the dPA process to ensure the refills were appropriate.

Continue to check the BCBSTX provider website and the Blue Review in the coming weeks, for additional information from BCBSTX.