Claims

Participating physicians, professional providers, ancillary and facility providers are requested to submit claims electronically to Blue Cross and Blue Shield of Texas (BCBSTX) within 95 days of the date of service, or by using the standard CMS-1500 or UB04 claim form.

Services billed beyond 95 days from the date of service are not eligible for reimbursement.

Participating physicians, professional providers, ancillary and facility providers may not seek payment from the member for claims submitted after the 95-day filing deadline.

Electronic Claim Submission

• Payor ID – 66001
• 9-digit Medicaid/CHIP ID
• The 3-Character prefix is preferred for billing electronically but is not required. Example – ZGC12345789

Provider ID# - Box 33b on 1500 Claim Form Guide

For a guide on how to fill out Provider ID# - Box 33b on the 1500 Claim Form, view page 56 of the National Uniform Claim Committee (NUCC) 1500 Health Insurance Claim Form Reference Instruction Manual .

BCBSTX Medicaid STAR, CHIP, CHIP Perinate and STAR Kids Three-Character Prefixes

• Medicaid (STAR) – ZGT
• CHIP – ZGC
• CHIP Perinate – ZGE
• STAR Kids – WZG

Paper Claim Submissions

• Claims mailing address:
  Blue Cross and Blue Shield of Texas
  PO Box 51422
  Amarillo, TX 79159-1422
• Claim Refunds for Non Medicare/Medicaid
  Blue Cross Blue Shield of Texas
  Refund and Recovery
  Dept. 0695
  P.O. Box 120695
  Dallas, TX 75312-0695
• Claim Refunds for Medicare/Medicaid
  Blue Cross Blue Shield of Texas
  Claims Overpayments
  Dept. CH 14212
  Palatine, IL 60055-4212
• Courier Address:
  Blue Cross Blue Shield of Texas
  Claims Overpayments
  Box 14212
  5505 North Cumberland Ave., Ste. 307
  Chicago, IL 60656-1471

Claims Status Inquiries

• Payer ID – HCSVC
• Three-Character prefix + Subscriber ID (Subscriber ID on the BCBSTX ID card) or
• Three-Character prefix + 9-digit Medicaid/CHIP ID

Appeals

Submit appeals within 120 calendar days from receipt of remittance advice (RA).

Mail

• Attach the Provider Appeal Request Form
• Appeals address:
  Blue Cross and Blue Shield of Texas
  Attn: Complaints and Appeals Department
  PO Box 660717
  Dallas, TX 75266-0717

Fax

855-235-1055

Email

GPDTXMedicaidAG@bcbsnm.com

Availity^® – Submit Claims Appeal Form Online

• Log into the Availity Provider Portal, select Payer Spaces from the top navigation menu and select BCBSTX.
• Within BCBSTX-branded Payer Spaces, select the Applications tab and click the BCBSTX Medicaid Provider Appeal Request Form.
• Select Open Form, complete the downloaded form and save as a .doc or .docx file.
• Click Add File and navigate to the folder where you saved the completed form and click Open.
• Click Submit.
• When the confirmation message displays, select Finish to return to the Availity Portal^® Home page or click Submit Another.

Electronic Commerce

BCBSTX providers who receive paper checks and Provider Claim Summaries (PCSs) via the U.S. Mail may wish to consider the electronic alternatives listed below for greater efficiency, convenience and security of information.

Electronic Funds Transfer (EFT)

EFT is a direct deposit claim payment from BCBSTX to your designated bank account.

• To enroll online for EFT, you must be a registered Availity^® Provider Portal user – there is no cost to register at Availity Provider Portal
• Texas Medicaid claims are normally finalized weekly on Mondays

Electronic Remittance Advice (ERA)

The ERA or ANSI 835 transaction is a HIPAA-compliant method of receiving claim payment and remittance details. The ERA can be automatically posted to your patient accounting system. You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of auto-posting software.

• Enroll online via the Availity Provider Portal
• An online Remittance Viewer tool is available via the Availity Portal to providers and billing services to search, view, save and print remittance information, even if the ERA is delivered to an appointed receiver.
• Interpreting the ‘PLB’ Segment on the 835 ERA Guide

Electronic Payment Summary (EPS)

When you enroll for the ERA, you are automatically enrolled for the EPS, which is an electronic version of the paper PCS. The EPS arrives faster than the PCS and is easier to archive for future retrieval.

Online EFT and ERA Enrollment Assistance

Learn how to enroll online for EFT and ERA transactions by referring to the Availity EFT & ERA Enrollment User Guide.

NOTE: To gain access to the above Blue Cross and Blue Shield of Texas Medicaid Tools you must be registered with Availity. Register today with no set-up fees, monthly fees or per-claim fees charged to providers by visiting the Availity website and selecting "Register".

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.