At Blue Cross and Blue Shield of Texas, we are committed to providing support to physician practices. We've designed useful tools for health care providers. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.
Attachments: Submit Recommended Clinical Review Requests
Attachments in Availity® Essentials allows you to submit recommended clinical review requests handled by BCBSTX. Learn More
Authorizations & Referrals
Authorizations & Referrals in Availity Essentials allows you to submit prior authorization, recommended clinical review and referral requests handled by BCBSTX. Learn More.
Eligibility and Benefits
It is important to check membership and coverage details for every patient at every visit, before you administer treatment.
To obtain fast, efficient, detailed benefits information for BCBSTX members, you can use Availity Essentials Eligibility and Benefits Inquiry. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information. Learn More.
BlueApprovRSM
BlueApprovR accessible in Availity® Essentials allows providers to submit inpatient and/or outpatient prior authorization and recommended clinical review requests for medical/surgical, specialty pharmacy drugs, and behavioral health services for members. Learn More.
Blue Distinction®
The Blue Distinction Specialty Care Program is a national designation program recognizing healthcare providers that demonstrate expertise in delivering quality specialty care safely, effectively, and cost-efficiently. The goal of the program is to help consumers find both quality and value for their specialty care needs, while providing a credible foundation for employers to design benefits tailored to meet their quality and cost objectives.
Blue Distinction Specialty Care has eleven areas of specialty care: bariatric surgery, cancer care, cardiac care, knee and hip replacement, maternity care, spine surgery, substance use treatment and recovery, transplants, fertility care, cellular immunotherapy, and gene therapy.
For specific information please select the Blue Distinction website.
Claim Inquiry Resolution - High Dollar, Pre-Pay Reviews
Claim Inquiry Resolution is accessed via our Electronic Refund Management system. The CIR function provides a method for inquiry submission related to High-Dollar, Pre-Pay Review requests for most Host (BlueCard® out-of-area) claims handled by BCBSTX. Learn More
Claim Reconsideration Requests
The Claim Reconsideration request option allows providers to electronically submit claim reconsiderations for situational finalized claim denials (including BlueCard® out-of-area claims), using Availity® Essentials Dispute Claim capability, which is anchored off the enhanced Claim Status tool. Learn more
Claim Status Tool
Availity® Claim Status Tool offers enhanced, real-time claim status functionality to help you manage and resolve claims processed by BCBSTX. Learn More
Clear Claim Connection™
Clear Claim Connection (C3) is a web-based code auditing tool, designed by McKesson Information Solutions, Inc., that enables BCBSTX to disclose our claim auditing rules and clinical rationale to our contracting provider network. C3 "mirrors" how BCBSTX's current code auditing software evaluates code combinations during the adjudication of a claim. Learn More
CoverMyMeds®
CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization requests for prescription drugs that are part of the BCBSTX pharmacy PA program. Learn More
DNoA Connect
DNoA Connect is a provider self-service tool where dental offices can conveniently connect to patient information for members with BlueCare DentalSM. It was designed to help providers manage their administrative tasks as quickly and efficiently as possible. Learn More
Electronic Claim Submission
Availity Essentials Claim Submission tool allows providers to quickly submit electronic Professional (ANSI 837P) and facility, or Institutional (ANSI 837I) claims or encounters to BCBSTX, at no cost. Learn More
Electronic Clinical Claim Appeal Request
Dispute Claim allows providers to electronically submit appeal requests for specific clinical claim denials through the Availity® Essentials. Learn More
Electronic Refund Management
Electronic Refund Management can help simplify your overpayment reconciliation and related processes. Learn More
Fee Schedules (Professional Providers)
The Availity Fee Schedule Listing tool allows professional providers participating with BCBSTX to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform. Learn More
Manage My Organization
Manage My Organization in Availity Essentials allows administrators and administrator assistants to add, edit, and/or delete provider(s) information within your organization(s) for easy data entry when submitting transactions via Availity handled by BCBSTX. Learn more.
Medical Record Status Viewer
Medical Record Status Viewer allows providers to confirm receipt (up to 4) of the most recent medical records submitted by mail or fax to BCBSTX for claim processing and prior authorization requests. Learn More
Message This Payer
Message This Payer in Availity Essentials allows providers to send secure messages to BCBSTX for claim management questions and follow along with the conversation history. Learn More
National Drug Code Units Calculator
The NDC Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System or Current Procedural Terminology (CPT®) codes to NDC units. Learn More
OptiNet® Assessment Tool
OptiNet is an online assessment tool developed by Carelon Medical Benefits Management to collect modality-specific data from imaging providers. This tool is as an enhancement to our Advanced Imaging Utilization Management program, which Carelon administers for BCBSTX. Learn More
Patient Care Summary
The Availity Patient Care Summary provides an electronic health record sourced from claim-based information collected by BCBSTX from physicians, pharmacies, labs and other health care providers based on the last 24 months of claims data. Learn More
Patient Cost Estimator
The Patient Cost Estimator is a member liability estimator tool. This free online tool can provide you with a real-time, estimated member share amount at the time of service, while the patient is still in your office, prior to claim submission. Learn More
Patient ID Finder
Patient ID Finder in Availity Essentials allows providers to obtain the BCBSTX patient ID number and group number by entering patient-specific data elements. Learn More.
Physician Efficiency, Appropriateness, and Quality Program
The PEAQSM program evaluates physician performance in a transparent and multidimensional way. Learn More
Provider Correspondence Viewer
Provider Correspondence Viewer in Availity Essentials allows providers to view, download and/or save specific documents related to the NPI and Tax ID associated with your Availity registration. Learn more
Provider Data Management
Availity Provider Data Management allows professional, facility and ancillary providers to quickly update, validate and attest to the accuracy of their information on file with BCBSTX. Learn more
Provider Claim Summary
The Provider Claim Summary application allows users to readily view, download, save and/or print Provider Claim Summary reports online, at no additional cost. Learn more
Remittance Viewer
Availity Remittance Viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by BCBSTX in the 835 Electronic Remittance Advice. Learn More