Update: Special Severe Weather Message for Providers in the HealthSelectSM Network
Recovering from a natural disaster like Hurricane Harvey is never easy. Blue Cross and Blue Shield of Texas (BCBSTX) is here to help network providers as well as participants.
For phone inquiries and requests, hours of operation are normal:
(Monday – Friday) 6 a.m. – 6 p.m.
- (Saturday – Sunday) 9 a.m. – 1 p.m. Provider Customer Service: (800) 451-0287
- Utilization Management: (800) 354-2354
To Check Eligibility:
The quickest way to access HealthSelect participant information like eligibility, benefits and patient clinical summaries is online through Availity® or your preferred web vendor. To learn more about online solutions, see the Provider Tools section on the BCBSTX Provider website.
Provider Customer Service and Utilization Management are available from 8 a.m. – 8 p.m. until further notice.
- Provider Customer Service: (800) 451-0287
- Utilization Management: (800) 441-9188
To verify HealthSelect plan participants' eligibility and benefits if you don't have internet access:
- Provider Customer Service: (877) 299-2377
- Utilization Management: (855) 896-2701
Claims and Provider Reimbursement Payments
- Include your National Provider Identifier on all claims to ensure accurate and timely claim processing
- Bill BCBSTX directly for all services rendered to patients with BCBSTX coverage. We will then compensate you based on each specific patient's (participant) 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 of your permanent location.
- Use the Availity provider portal at www.Availity.com if you have online access. This portal provides access to participant's real-time eligibility & benefits and claims status information, as well as offers batch or web claim submissions.
- A claims system edit will be implemented based on participant zip codes associated with the 60 impacted counties specified in the declaration areas until further notice. This means claims will suspend for the specific edit, enabling claims examiners to review claims for services rendered to impacted participants to determine if any of the exceptions apply.
Note: 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.
Referrals / Prior-Authorization / Extensions / Clinical Care:
- The BCBSTX prior authorization unit has extended hours from 8am – 8pm until further notice.
- BCBSTX will review requests as we normally do and manage issues on a case by case basis. This will ensure that our participants have access to timely care that's needed during this time. If your patients don't have their ID card, they should call participant services or print a temporary card from Blue Access for MembersSM
Note: Medicare Advantage patients should call participant services if they don't have their ID card.
- Magellan can be reached at (800) 729-2422
- eviCore can be reached at (855) 252-1117 or online at eviCore.com
- Quest Diagnostics, Inc. can be reached at (888) 277-8772 or online at QuestDiagnostics.com/patient
- Clinical Pathology Laboratory (CPL) can be reached at (800) 595-1275 or online at cpllabs.com
Note: 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 participant's eligibility and the terms of the participant'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 participant's ID card.
IF APPLICABLE OFFER SERVICE REMINDER for Virtual Visit – Promotions (Reminder if participant has immediate need they should seek emergency care.)
- MDLIVE is offering free virtual medical consultations through 9/16/2017. MDLIVE will connect you with a board-certified doctor 24/7 in your state for free. To access your free visit, call MDLIVE at (888) 959-9516 use promo code HARVEY.
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 participant services. A PHA can help find a doctor or health care professional in their network.
- Your patients should bring their BCBSTX participant ID card when they get care.
- If your patients don't have their ID card, they can print a temporary card from Blue Access for Members or call participant services to have a PHA send the ID card information over the phone. Participants can also download their ID card from the BCBSTX App on a smart phone. Text BCBSTX APP to 33633 to download the app.
HealthSelect providers and participants of the 60 disaster counties or those impacted by Harvey will be covered by Governor Greg Abbott's proclamation.
To help all HealthSelect participants for the duration of the governor's proclamation, we are:
- Authorizing up to a 90-day supply of prescription medications for participants
- Not requiring prior-authorization or referrals (participants' benefit coverage will apply)
- Allowing claims for a plan participant to receive services out-of-network if necessary, without a referral
- Extending claim filing deadlines for providers
- Working with participants to extend premium payment deadlines
- Authorizing payment for necessary medical equipment, supplies, and services regardless of the date on which the service, equipment, or supplies were most recently provided
- Waiving the penalty for failure to obtain Prior Authorizations when services are received at an in-network facility
- Participants with an immediate need should seek emergency care
- A Personal Health Assistants (PHA) can assist with verifying provider availability
- Keeping pharmacy customer service open 24 hours
- Participants in the impacted ZIP Codes can receive customized assistance from a PHA by calling
- Processing claims for emergency transport from one facility to another will be at the in-network benefit level
- Includes out-of-network provider reimbursement amounts previously established
- Continuing BCBSTX Member Service hours of operation from 7 a.m. – 7 p.m. Monday – Friday and 7 a.m. – 3 p.m. Saturday, Central time.
Note: Participants can call Magellan at (800) 729-2422 to access 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.
Additional help for HealthSelect participants with a mailing address in one of the 60 counties covered by Governor Greg Abbott's disaster area proclamation:
- No penalty for failure to obtain PCP referral
- In-network benefits apply when services are received from an in-network HealthSelect provider
- No penalty for failure to obtain Prior Authorizations when services are received at an in-network HealthSelect facility
- Applies to all plans, not just HealthSelect in-area plans
Note: The above applies to participants even when their services need to be rendered outside of the declared counties