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Home / How to Submit Claim to Anthem Blue Cross Blue Shield

How to Submit Claim to Anthem Blue Cross Blue Shield

Claims

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

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

Participating physicians, professional providers, coincident and facility providers may not seek payment from the fellow member for claims submitted afterward the 95-solar day filing borderline.

Electronic Claim Submission

  • Payor ID – 66001
  • 9-digit Medicaid/Scrap ID

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

Paper Claim Submissions

  • Claims mailing accost:
    Blue Cross and Bluish Shield of Texas
    PO Box 51422
    Amarillo, TX 79159-1422
  • Merits Refunds for Not 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 Cantankerous Blue Shield of Texas
    Claims Overpayments
    Dept. CH 14212
    Palatine, IL 60055-4212
  • Courier Accost:
    Blueish Cross Blue Shield of Texas
    Claims Overpayments
    Box 14212
    5505 Northward Cumberland Ave., Ste. 307
    Chicago, IL 60656-1471

Claims Condition Inquiries

  • Payer ID – HCSVC

Appeals

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

  • Members tin ask for an External Medical Review (EMR) and Country fair Hearing from the land Medicaid program and become information well-nigh how the process works in our provider warning Contained Review Organization (IRO) and EMR Provider Preparation information.
  • You tin too admission the EMR Preparation information.

Mail

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

Fax

1-855-235-1055

E-mail

Availity® – Submit Claims Entreatment Form Online

  • Log into the Availity Provider Portal, select Payer Spaces from the height navigation menu and select BCBSTX.
  • Within BCBSTX-branded Payer Spaces, select the Applications tab and click the BCBSTX Medicaid Provider Appeal Request Form.
  • SelectOpen up Course, consummate the downloaded form and save as a .doc or .docx file.
  • ClickAdd File and navigate to the folder where you saved the completed form and clickOpen.
  • ClickSubmit.
  • When the confirmation message displays, selectFinish to render to the Availity Portal® Domicile page or clickSubmit Another.

Electronic Commerce

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

Electronic Funds Transfer (EFT)

EFT is a straight deposit claim payment from BCBSTX to your designated depository financial institution account.

  • To enroll online for EFT, you must exist a registered Availity® Provider Portal user – there is no price 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 merits payment and remittance details. The ERA tin be automatically posted to your patient bookkeeping system. You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of car-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 impress 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 EPSarrives faster than the PCS andis easier to annal for future retrieval.

Online EFT and ERA Enrollment Help

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. Annals today with no gear up-up fees, monthly fees or per-merits 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 data 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 equally Availity. If yous have any questions nigh the products or services provided by such vendors, you should contact the vendor(s) straight.

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Source: https://www.bcbstx.com/provider/medicaid/claims-and-eligibility/claims