The fastest way to conduct business with BCBSTX throughout the entire claims process is via Electronic Data Interchange - the computer transmission of standardized information. EDI transactions are often identified by numbers assigned by the American National Standards Institute. Here are some examples:
- Eligibility & benefits inquiry/response (ANSI 270/271)
- Prior authorizations and referrals (ANSI 278)
- Electronic claim submission (also known as Electronic Media Claims, or EMC) [ANSI 837P (Professional) or ANSI 837I (Institutional)]
- Claim status request/response (ANSI 276/277)
- Claim payment via Electronic Funds Transfer (ANSI 835 EFT)
- Electronic Remittance Advice (ANSI 835 ERA), or delivery of claims payment information
Online Transaction Schedule
Online Eligibility and Benefits (270/271) and Claims Status (276/277) transactions may be conducted almost continuously, except for Sunday, 8 p.m. to midnight, (CST)*.
* Non-routine downtime will be communicated via designated third-party independent vendor websites at least one week in advance.
Getting Started
Establish a vendor connection. Some electronic transactions, such as EFT, may be set up directly with BCBSTX. For other EDI transactions, you will need to enlist the services of a third-party electronic business vendor, such as Availity® Essentials.
With Availity Essentials, health care providers can conduct various transactions at no charge. It’s a comprehensive solution that supports numerous payers. Learn more about Availity.
Availity Essentials Pro is a fee for service revenue cycle management solution that simplifies claim and payment processing while delivering intelligent reporting and analytics that pinpoint revenue cycle trends. Learn more about Essentials Pro.
Electronic Data Interchange Transactions
With EDI, health care providers can save time, money and delays in claims processing. View, track, and monitor claim status reports electronically…and more. Learn more about EDI Transactions.
Electronic Funds Transfer/Electronic Remittance Advice
EFT and ERA allow providers to securely and promptly receive funds and details regarding claims payment and remittance. Learn more about EFT and ERA.
Electronic Refund Management
This online refund management tool will help simplify overpayment reconciliation and related processes. The eRM application is available at no additional charge. Learn more about eRM.
Provider Tools
We are committed to providing support to health care providers. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more. Learn more about provider tools.
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Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized or has a recommended clinical review is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate or contract of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.
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 third party vendors and the products and services they offer.