Automated Phone System Change for Behavioral Health Services
Checking eligibility and benefits electronically through the Availity® Provider Portal or your preferred Web vendor is the quickest way to access behavioral health coverage information for Blue Cross and Blue Shield of Texas (BCBSTX) members. Online eligibility and benefit quotes include the patients’ coverage status and benefit details, such as an applicable copayment, coinsurance, deductible amounts, and preauthorization requirements.
However, if a call to BCBSTX is needed to verify patient coverage for behavioral health services, starting Dec. 16, 2018, providers must first obtain eligibility and benefit details through the Interactive Voice Response (IVR) phone system. The IVR quotes the same level of eligibility and benefits information as a Customer Advocate provides. Our Customer Advocates will continue to be available for additional assistance and more complex benefit quotes.
To learn more about online solutions, refer to the Provider Tools page in the Education and Reference Center of our Provider website. For IVR navigational assistance, refer to the Eligibility and Benefit Caller Guide located in the Claims and Eligibility section of our website.
Note: The IVR phone system information is not applicable to government programs (Medicare Advantage and Texas Medicaid) member policies. For government programs eligibility and benefits requests via phone, refer to the number on the member’s BCBSTX ID card.
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 any 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 provided by third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.