Transcription of Blue Advantage HMO Quick Reference Guide
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Major Characteristics Benefits, Eligibility, Claims Status or Verification Claim Reviews, All Correspondence Prior Authorizations and Referrals Laboratory Services Behavioral Health Services (Mental Health and Chemical Dependency) Blue Advantage HMO membersmust select a Blue Advantage HMOP rimary Care Physician (PCP). Blue Advantage providers may onlybill for copayments, cost share(coinsurance) and deductibles, whereapplicable. Some services may be self-referredto a Blue Advantage HMO physician orprofessional provider ( annual wellwoman exam, annual routine eye exam)as indicated by the member s benefitplan. To receive benefits, all medical caremust be directed by the selected BlueAdvantage HMO PCP. A PCP referralis required to all Blue Advantage HMOspecialist receive benefits, referrals to out- Eligibility and benefitinformation may be obtainedthrough or aweb vendor of your choice orcall Blue Advantage HMOP rovider Customer Service:1-800-451-0287* Claim Status may beobtained through the AvailityClaim Status Tool or a webvendor of your choice.
The Electronic Payor ID for BCBSTX is 84980. - For support relating to claims that are being sent to the Availity platform, submitters should contact Availity Client Services at 1-800-282-4548. - For support relating to claims and/or other transactions available on the Availity portal or other Availity platforms, submitters should contact ...
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