BlueCard^® Claim Guidelines

• Obtain a copy of member's most current identification (ID) card. Be sure to include the complete ID number including the three-character prefix as it appears on the member's ID card when submitting claims.
• Please do not request full payment up front.
• Submit the claim to Blue Cross and Blue Shield of Texas (BCBSTX) electronically.

Generally, claims should be filed to the local Blue Cross and Blue Shield Plan. However, there are unique circumstances for some ancillary providers (Independent Clinical Laboratory, Durable/Home Medical Equipment and Supplies and Specialty Pharmacy) based on the type of provider and service. The local Blue Plan as defined for ancillary services is as follows:

Independent Clinical Laboratory (Lab)

• The Plan in whose state* the specimen was drawn.

Durable/Home Medical Equipment and Supplies (DME)

• The Plan in whose state* the equipment was shipped to or purchased at a retail store.

Specialty Pharmacy

• The Plan in whose state* the ordering physician is located.

* If you contract with more than one Plan in a state for the same product type (i.e., PPO or Traditional), you may file the claim with either Plan.

Refer to the BlueCard^® Provider Manual for additional information.

For any questions concerning claims adjudication, please contact BCBSTX at 1-800-451-0287.