Benefit Information Accessible in the IVR Phone System

The Blue Cross and Blue Shield of Texas (BCBSTX) Interactive Voice Response (IVR) phone system provides access to the same patient eligibility and benefits information as a Customer Advocate provides.  As a result, on Dec. 12, 2016, Customer Advocate assistance was removed for several common benefit categories available through the Interactive Voice Response (IVR) phone system.  Remain assured; our Advocates will continue to be available for more complex benefit quotes.

Blue Cross and Blue Shield of Texas (BCBSTX) is committed to providing efficient and secure access to patient information. To better assist providers with understanding the recent IVR change, a list of the benefit categories that are currently contained in the IVR is included below. This listing is continually reviewed and may vary across our different BCBSTX networks, products and/or group policies. Also included below is a separate category list for Federal Employee Program (FEP) members. 

When navigating the IVR to determine patient coverage or connecting with a Customer Advocate to request pre-determination of benefits status, it is imperative that you select the exact benefit category that will be rendered for the patient. This will ensure that you receive the most accurate benefit information associated with your request.

Checking eligibility and benefits electronically through Availity™ or your preferred Web vendor is the quickest way to access information for BCBSTX members. To learn more about online solutions, refer to the Education and Reference Center/Provider Tools section of our website at bcbstx.com/provider. For IVR navigational assistance, refer to the Eligibility and Benefit Caller Guide found on our Provider website.

Checking 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 and the terms of the member’s certificate of coverage applicable on the date services were rendered.  If you have questions, please call the number on the member’s ID card.

Availity is a trademark of Availity, L.L.C., 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 any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.