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  • Medical Claim Form - Bcbstx.com

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Dallas, Texas 75266-0044. Each item on this form needs to be completed. ... Patient's Full Name (Last, First, Middle). City & State. Zip Code. Patient's Sex .

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If you have any questions about the submission process or about your claim, you can call a BCBSTX Personal Health Assistant toll-free at (800) 252-8039 (TTY:711), Monday-Friday 7 a.m.-7 p.m. and Saturday 7 a.m.-3 p.m. CT.

Claim review requests must be submitted in writing on the Claim Review form. There are two (2) levels of claim reviews available to you. BCBSTX will complete the first claim review within 45 days following the receipt of your request for a first claim review.

BCBSTX only accepts medical records through the Availity Portal in response to requests for additional medical record documentation used for quality and risk adjustment purposes. Administrator Instructions: Select Availity Enrollment Center > Medical Attachments Setup, then enter required data.

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

You can also use the "Adjust a Claim" option within the IVR phone system to connect with an agent and request claim adjustments at 1-800-451-0287.

Availity provides administrative services to BCBSTX....How to access and use Availity's Claim Submission tool: Log in to Availity. Select Claims & Payments from the navigation menu. Select Professional Claim or Facility Claim. Within the tool, select your Organization, Transaction Type and Payer. Complete the required fields.

Call us at 1-866-292-6745 (TTY 711). We're open between 8 a.m. – 8 p.m., local time, 7 days a week.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232