Eligibility and Benefits

Check eligibility and benefits before every scheduled appointment. Eligibility and benefit quotes include membership and coverage status, prior authorization requirements and optional recommended clinical review and determination that the provider is in-network for the patient’s policy. Other significant details, such as applicable copayment, coinsurance and deductible amounts are also included. It’s strongly recommended that providers ask to see the member’s ID card for current information and photo ID to guard against medical identity theft. When services may not be covered, members should be notified that they may be billed directly.

Checking Online

Providers are strongly encouraged to use Availity® Essentials or their preferred vendor to check eligibility and benefits. With Availity’s Eligibility and Benefits Inquiry, users can access printable results that include up to date benefit information.

  • Patient/Subscriber information
  • Group Number
  • Group Name
  • Plan/Product
  • Current Effective Dates*
  • Copayment*
  • Deductible (original and remaining amounts)
  • Out-of-pocket (original and remaining amounts)
  • Coinsurance
  • Limitations/Maximums*
  • Prior authorization and RCR Indicators and Contacts

* These benefit categories will only appear if applicable to the services being rendered.

You must be registered with Availity to access Eligibility and Benefits Inquiry and other online resources offered by Availity. For additional details refer to the Availity Eligibility and Benefits User Guide.

Some patient transactions may instruct you to call Provider Customer Service to obtain benefit details. Our staff remains available to assist with these benefit inquiries as needed.

Online Transaction Schedule

Online Eligibility and Benefits (270/271) 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.

Availity Training

Online training sessions — Learn More

Checking via Telephone

For most of our members, if you cannot submit your eligibility and benefit inquiries online, this information can also be easily obtained through our Interactive Voice Response automated phone system at 800-451-0287, available Monday through Friday, 6 a.m. to 11:30 p.m., CST, and Saturday, 6 a.m. to 6 p.m., CST.

Exceptions

For government programs member information, the provider customer service phone numbers are as follows:

Call BlueCard® Eligibility at 1-800-676-BLUE (2583) for eligibility and benefits for out of state members with Blue Cross and Blue Shield. Learn more

For Federal Employee Program® members, eligibility and benefits can be obtained by calling 1-800-442-4607.

Related Resources

Medical Policy

Checking of eligibility and/or benefit information 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, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.

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.