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| HMO Blue® Texas Online Orientation Check List |
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BCBSTX Provider Web site - www.bcbstx.com/provider
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HMO Blue Texas Physician & Other Professional Provider – Provider Manual -under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual.
- Limited Provider Networks – if applicable (Section A)
- HMO Blue Texas ID Card (Section B) and link to Sample of “Standard” HMO Blue Texas ID Card
- Physician & other Professional Provider Roles & Responsibilities (Section B)
- Referrals Required (Section B)
- Filing Claims (Section F)
- Provider Customer Service – 1-877-299-2377
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HMO Blue Texas Quick Reference Guide (QRG) – under Provider Library, click on Reference Guides, then click on the offering – HMO Blue Texas Quick Reference Guide
- Review each column of the Quick Reference Guide:
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iEXCHANGE - Automated Precertification & Referral System
- Web & IVR applications – Go to www.bcbstx.com/provider, under UM/QI/Medical Management, click on iEXCHANGE. On the iEXCHANGE Home page you can find information about the Web application as well as the Interactive Voice Response (IVR) phone system 1-800-413-0869. Also refer to the iEXCHANGE box on the left hand side of the Home page for the following information:
- Texas iEXCHANGE Support Desk – 1-800-441-9188, select 1, then select select 3 (preauthorizations & referrals), then select 2 (for assistance with the iEXCHANGE system)
- Utilization Management Department – 1-800-441-9188, select 1 (English), then select 3 (preauthorizations & referrals), the select 3 (preauthoruzations & referrals) again, then select 2 (Medical/Surgical)
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Laboratory Services – Go to www.bcbstx.com/provider, under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual, then select Section B or click on Laboratory Services to access the information on the Web site.
- Quest Diagnostics, Inc. is the exclusive outpatient clinical reference laboratory for HMO Blue Texas effective June 1, 2010
- LabCorp is the exclusive outpatient clinical reference laboratory for HMO Blue Texas through May 31, 2010
- Reimbursable Lab Services List – if performed in physician’s office
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Radiology Services - Go to www.bcbstx.com/provider, under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual, then select Section B or click on Radiology Services to access the information on the Web site.
- Precertification is required for the following High tech outpatient diagnostic radiology procedures: CT/CTA scans, MRI/MRA scans, SPECT/Nuclear Cardiology studies and PET scans (excludes radiology services provided during emergency room visits, in-patient admissions, out-patient surgeries and 23 hour observation).
- For Precertification, just log onto AIM’s Provider Portal and complete the online questionnaire that identifies the reasons for requesting the exam or contact American Imaging Management (AIM) at 1-800-859-5299. Note: Requests for these procedures cannot be processed in the iEXCHANGE System.
- View the CPT Codes affected by this program.
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Filing Claims - Go to www.bcbstx.com/provider, under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual, then select Section F.
- Electronic Claims - Availity – www.availity.com or 1-800-AVAILITY (282-4548)
- Blue goes Green
- Claims Submission
- Proof of Timely Filing
- Clean Claim Information
- Claim Appeal/Reconsideration Review Process
- Refunds & Recoupments
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Filing Claims – For OBGyn Physicians
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Pharmacy - Specialty Program
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HMO Blue Texas Provider Directory
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Changes Affecting Your Provider Record, Change in Your Status or Changes Affecting Your NPI Number, Added a New Office Location, Moved to a New Office Location? – Call (972) 996-9610, press 3 or Go to www.bcbstx.com/provider, and click on ”Change Your Information”, complete the form and submit via online or print and fax it to the indicated number.
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Experience. Wellness. Everywhere.SM – BCBSTX’ New Wellness Initiatives/ Programs
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Review Home Page of BCBSTX Provider Web site
- Go to www.bcbstx.com/provider
- Provider Finder (2 areas)
- Provider Library (2 areas)
- Forms (2 areas)
- Electronic Commerce (2 areas)
- General Reimbursements (2 areas) password protected-enter password
- Blue Review (2 areas)
- Pick Paperless…Receive your Blue Review via e-mail (ICON)
- Change Your Information (ICON)
- Refer to In-Network Providers (ICON)
- Medical Policy
- Credentialing/Contracting
- UM/QI/Medical Management
- Pharmacy
- Provider Tools/Programs
- iEXCHANGE IVR/Web
- What’s New
- Disclosure Notices
- Workshop Schedule
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Review Secured Page of BCBSTX Provider Web site
- Go to www.bcbstx.com/provider
- Medical Policies
- Manuals
- Recoupments & Refunds
- Reimbursement Schedules & Related Information
- Bundling Information
- Provider Tools
- All Product News
- HMO Blue Texas
- Precertification/Notification/Referral Requirements Lists
revised 04/2010
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