Blue Cross Blue Shield of Texas Predetermination Form

Contact Us

Contact Name	Address/Phone/Email/URL
Blue Cross and Blue Shield of Texas (BCBSTX)	1001 E. Lookout Drive Richardson, TX 75082 800-451-0287 TDD: 800-735-2989 (for hearing impaired) BCBSTX provider portal
Electronic Commerce Services For information about Electronic Data Interchange (EDI) transactions, such as electronic claim submission	Need Assistance/Have Questions? Email ecommerceservices@bcbstx.com
BCBSTX Provider Customer Service Numbers
BlueCard® BlueCard is our out-of-area program that allows members from other Blue Cross and Blue Shield Plans to receive health care benefits when travelling or residing in another Blue Plan's service area.	Eligibility and benefits (out-of-state subscribers) 800-676-BLUE (2583) Claim status inquiries (out-of-state subscribers) contact Availity® or other electronic connectivity vendor. Claim adjustments call 800-451-0287* *interactive voice response (IVR) system — to access, you must have document control number (claim number)
Blue Choice PPOSM and indemnity plans	Eligibility and benefits contact your electronic connectivity vendor, Availity or other electronic connectivity vendor or call 800-451-0287* Claim status inquiries contact Availity or other electronic connectivity. Claim adjustments call 800-451-0287* *interactive voice response (IVR) system – to access, you must have document control number (claim number)
Blue Cross Medicare Advantage	Customer Service 877-774-8592
Care Management Programs	855-462-1781
Federal Employee Program (FEP) — PPO	Eligibility and benefits contact Availity or other electronic connectivity vendor or call 800-442-4607* Claim status inquiries contact Availity or other electronic connectivity. Claim adjustments call 800-451-0287* *interactive voice response (IVR) system — to access, you must have document control number (claim number) Behavioral health services mental health and chemical dependency prior authorization and referrals (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services) call 800-528-7264 Behavioral health services – claims status inquiries contact Availity or other electronic connectivity vendor or call 800-442-4607* Behavioral health services – claim adjustments call 800-442-4607
Blue Essentials	Eligibility and benefits contact Availity or other electronic connectivity vendor or call 877-299-2377* Claim status inquiries contact Availity or other electronic connectivity vendor Claim adjustments call 877-299-2377* *interactive voice response (IVR) system – to access, you must have document control number (claim number)
Medical Management Correspondence for the Health Insurance Marketplace for Blue Advantage HMO Members	Fax: 866-589-8254 Blue Cross Blue Shield of Texas Medical Care Management P. O. Box 660027 Dallas, TX 75266-0027
Prior authorization of Medical Services for the Health Insurance Marketplace for Blue Advantage HMO Members	855-462-1785 Fax: 866-589-8253
University of Texas (UT Select)	Eligibility and benefits contact Availity or other electronic connectivity vendor or call 800-451-0287* Claim status inquiries contact Availity or other electronic connectivity vendor Claim adjustments call 877-299-2377* *interactive voice response (IVR) system – to access, you must have document control number (claim number)
Other Customer Service Numbers
Behavioral health services mental health and chemical dependency	For prior authorization and referrals managed by BCBSTX: (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services) Call 800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. Submit completed forms to: BCBSTX Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax 877-361-7646 Claims submission address: Blue Cross and Blue Shield of Texas P O Box 660044 Dallas, TX 75266-0044 For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc. 800-729-2422
Behavioral health services - claims status inquiries	For services managed by BCBSTX: Contact Availity or other electronic connectivity vendor or call 800-451-0287* *interactive voice response (IVR) system — to access, you must have full member's information (for example, member's ID, patient's date of birth, etc.) For services managed by Magellan: Contact Availity or other electronic connectivity vendor or call Magellan Behavioral Health 800-729-2422
Prime Therapeutics	Pharmacy help desk: 888-229-2812 For PPO questions: 800-521-2227 For HMO questions: 877-299-2377* *interactive voice response (IVR) system - to access, you must have full member's information (for example, member's ID, patient's date of birth, etc.)
AIM Specialty Health®'	800-859-5299 AIM Specialty Health
eviCore healthcare	855-252-1117 or online at eviCore
Claim filing address for Commercial products	All claims should be filed electronically. If a provider must file a paper claim, mail claim to Blue Cross and Blue Shield of Texas P.O. Box 660044 Dallas, TX 75266-0044
Claim review submission address	Blue Cross and Blue Shield of Texas P.O. Box 660044 Dallas, TX 75266-0044 Request for claim review form and instructions
Availity® --- Authorizations & Referrals submissions (replacing iExchange system) — electronic claims filing system	File electronic claims using Payer ID #84980 Submit prior authorization and referrals for BCBSTX managed services via Authorizations & Referrals Availity client services 800-AVAILITY (282-4548) Availity website EDI Guide
Benefit disclosure information (form available online)	Send requests to: Blue Cross and Blue Shield of Texas Pre-Service Allowed Benefit Disclosure Request P.O. Box 650489 Dallas, TX 75265-0489 Fax: 972-766-0371 Please do not send patient-specific predetermination information to this address or fax number.
Predetermination requests (form available online)	Mail: Blue Cross and Blue Shield of Texas Attn: Predetermination Dept. P.O. Box 660044 Dallas, TX 75266-0044 For status call: 800-451-0287* (Blue Choice PPO) 877-299-2377* (Blue Essentials and Blue Advantage HMO) 877-774-8592 (Blue Cross Medicare Advantage PPO & HMO) *interactive voice response (IVR) system - to access, you must have full member's information (for example, member's ID, patient's date of birth, etc.) For urgent requests only: Fax to: 888-579-7935 Predetermination form and Instructions for submitting requests for predetermination Note: Predetermination requests for members with Blue Cross and Blue Shield benefits in another state should be sent to the Plan indicated on the member's ID card.
Utilization management/Medical Management/Case Management	Referrals and inpatient prior authorizations 800-441-9188 Fax: 800-252-8815 or 800-462-3272 Case management 800-462-3275 Fax: 800-778-2279 Messages may be left in a confidential voice mailbox after business hours. Wellness and clinical practice guidelines
Network Management Office Locations
Select the office closest to your location. TO AVOID DELAY, DO NOT SUBMIT FORM TO MULTIPLE AREAS/OFFICES. Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Network Management.
Abilene, Midland San Angelo	Blue Cross and Blue Shield of Texas 1001 E Lookout Drive Richardson, TX 75082-4144 361-878-1623 Fax: 361-852-0624 Email to submit provider inquiries and questions
Austin	Blue Cross and Blue Shield of Texas Arboretum Plaza II 9442 Capital of Texas Hwy N, Suite 500 Austin, TX 78759-7228 800-336-5696 512-349-4847 Fax: 512-349-4853 Email to submit provider inquiries and questions
Amarillo	Blue Cross and Blue Shield of Texas 1001 E Lookout Drive Richardson, TX 75082-4144 361-878-1623 Fax: 361-852-0624 Email to submit provider inquiries and questions
Corpus Christi and The Valley	Blue Cross and Blue Shield of Texas 4444 Corona, Suite 148 Corpus Christi, TX 78411-4375 361-878-1623 Fax: 361-852-0624 Email to submit provider inquiries and questions
Dallas	See "North Texas"
El Paso	Blue Cross and Blue Shield of Texas 114 Mesa Park Dr. Suite #300 El Paso, TX 79912 -6156 915-496-6600, press 2 Fax: 915-496-6614 Email to submit provider inquiries and questions
Fort Worth	See "North Texas"
Golden Triangle (Beaumont, Orange, Port Arthur)	Blue Cross and Blue Shield of Texas 2615 Calder St, Suite 700 Beaumont, TX 77702-1954 800-637-0171, press 3 or 713-663-1149 Fax: 713-663-1227 Email to submit provider inquiries and questions
Houston	Blue Cross and Blue Shield of Texas 1800 West Loop South, Suite 600 Houston, TX 77027-3279 800-637-0171, press 3 713-663-1149 Fax: 713-663-1227 Email to submit provider inquiries and questions
Laredo	See "San Antonio and Laredo"
Lubbock	Blue Cross and Blue Shield of Texas 1001 E Lookout Drive Richardson, TX 75082-4144 361-878-1623 Fax: 361-852-0624 Email to submit provider inquiries and questions
McLennan and Wichita Counties	Blue Cross and Blue Shield of Texas 4444 Corona, Suite 148 Corpus Christi, TX 78411-4375 361-878-1623 Fax: 361-852-0624 Email to submit provider inquiries and questions
North Texas Dallas, Fort Worth, East Texas (Excludes McLennan and Wichita counties)	Blue Cross and Blue Shield of Texas 1001 E. Lookout Drive Richardson, TX 75082-4144 800-749-0966 972-766-8900 Fax: 972-766-2231 Email to submit provider inquiries and questions
San Angelo	See "Abilene, Midland and San Angelo"
San Antonio and Laredo	Blue Cross and Blue Shield of Texas 17806 IH 10 West, Bldg II, Suite 200 San Antonio, TX 78257-8222 361-878-1623 Fax: 361-852-0624 Email to submit provider inquiries and questions
The Valley	See "Corpus Christi and The Valley"
Wichita County	See "McLennan and Wichita Counties"
Ancillary Network Management
Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Ancillary Network Management.
Independent Clinical / Specialty Labs	Phone: 713-354-8140 Fax: 713-663-1227 Email to submit provider inquires
Ambulance IP Only Rehab Facilities Imaging LTAC (Long-Term Acute Care Hospital) Radiation Therapy Center	Phone: 972-766-4628 Fax: 972-766-2231 Email to submit provider inquires
Home Health Skilled Nursing Facilities Post-Acute Brain Injury Facilities	Phone: 210-558-5101 Fax: 210-558-5176 Email to submit provider inquires
Diabetic Management Disease Management Durable Medical Equipment (DME) Hearing Aid Supplier Prosthetics/Orthotics Sleep Studies Centers	Phone: 972-766-1613 Fax: 210-340-1401 Email to submit provider inquires
Home Infusion Therapy Home Health Dialysis Hospice Renal Dialysis	Phone: 972-766-5125 Fax: 210-340-1401 Email to submit provider inquires
Behavioral Health Facilities Psychiatric Facilities Residential Treatment Centers for Mental Health and Substance Abuse Facilities Note: For behavioral health professional providers, refer to the Network Management Office Locations listed above.	Phone: 972-766-1380 Fax: 713-663-1227 Email to submit provider inquires
Ambulatory Surgery Centers (ASC) – Independent, Non-Hospital owned Catherization Center Independent (Non-Hospital owned) Surgery Centers	Phone: 713-354-7033 Fax: 713-663-1227 Email to submit provider inquires
Birthing Centers Freestanding Emergency Rooms	Phone: 972-766-1110 Fax: 713-663-1227 Email to submit provider inquires
Blue Cross Medicare Advantage Network Management	1001 E. Lookout Drive Richardson, TX 75082 Phone: 972-766-7100 TexasMedicareAdvantageNetwork@bcbstx.com

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Source: https://publicsitestx.hcsc.net/provider/contact_us.html

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