General Reimbursement Information

Refer also to the Provider COVID Information page. 

The following resources provide you with the information needed to administer Blue Cross and Blue Shield of Texas (BCBSTX) plans for your patients. You can find provider manuals, reimbursement documents and procedures.

General Information

• Anesthesia Payment and Billing Update
• Participating Provider Fee Schedule Requests:

Professional Providers

- Refer to the Fee Schedules for via Availity tool to obtain immediate fees (at no charge) online or;

- Important Note:

As of 05/08/2023, the Professional Fee Schedule Request Form below is not operational and under redevelopment. To obtain required codes refer to the above Fee Schedules for via Availity Tool We apologize for any inconvenience and will get you access to the Fee Schedule forms as soon as possible.

Utilize the Professional Fee Schedule Request Form for an ample sample
  

Ancillary/Hospital Fee Schedule Request Form

Bundling Information

• ClaimsXten Rule Descriptions
• Clear Claim Connection

Outpatient Surgery Codes with Reimbursement Increase When Performed at an Ambulatory Surgery Center 

• Information
• Code List Effective 4/1/2022

Provider Manuals

View Manuals

Recoupments/Refunds

Recoupment Process

• Blue Choice PPO
• Blue Essentials^SM,Blue Advantage HMO^SM and Blue Premier^SM

Refund Policy

• Blue Choice PPO
• Blue Essentials^SM, Blue Advantage HMO^SM and Blue Premier^SM
• Provider Refund Form

Reimbursement Schedules and Related Information (Secure Content)

This section provides additional reimbursement details. In-network providers will need to enter a password to access this section of the site. If you do not know the password, please contact your Network Management office.