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BlueCross BlueShield of Texas
What's New
Electronic Refund Management (eRM) - November & December Webinars
Untimed Billing Procedure CPT Codes - Update
Calling us for claim status?
Preparing for ANSI 5010 and ICD-10
Formulary Changes 2010 to 2011
Availity Participating Provider Training Webinars - November 2010
Modifer 22 Submission Tips
Behavioral Health Program Changes Eff 01/2011
Multiple Surgery Pricing Per Session Methodology - Update

HMO Blue® Texas Claim Processing System - Update!

As of October 15, 2006, HMO Blue Texas has completed the system consolidation process and all HMO Blue Texas claims are now processed on the same claim processing system utilized for all other lines of Blue Cross and Blue Shield of Texas (BCBSTX) business, including PPO, POS and ParPlan/Traditional. This system consolidation allows for improved efficiency in processing of claims and responding to inquiries.  All HMO Blue Texas claims can now be found on the same Provider Claims Summary (PCS) and Electronic Remittance Advice (ERA) as all other BCBSTX products.

For providers that have a capitated agreement with HMO Blue Texas, the capitated service will indicate an ineligible reason of M20 on the PCS.  However, it will not indicate the member’s copayment amount.  The member is still responsible for the applicable copayment and it should be collected by your office at the time the services are rendered.  Please refer to the member’s ID card or you may contact HMO Blue Texas Provider Customer Service at the number indicated below to verify the appropriate copayment amount.

If you are experiencing difficulty accessing HMO Blue Texas claims through online inquiries, please contact the HMO Blue Texas Provider Customer Service department at 1- 877-299-2377 for assistance.

For further information about payment policies, medical policies and bundling methodologies or to request specific code to code bundling, please access the provider section of the BCBSTX Web site.

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a Mutual Legal Reserve Company, an Independent Licensee of the
Blue Cross and Blue Shield Association.
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