Date: Attn: Facility Provider Services Fax #: 9727667315 ANCILLARY PROVIDER ID REQUEST FORM Blue Cross and Blue Shield of Texas (BCBSTX)Facility Provider Services Blue Cross and Blue Shield of Texas.
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How to fill out the ANCILLARY PROVIDER ID REQUEST FORM Blue Cross And online
Filling out the Ancillary Provider ID Request Form for Blue Cross and Blue Shield of Texas is a straightforward process that ensures your information is accurately captured for claims processing. This guide will walk you through each section of the form to assist you in completing it online.
Follow the steps to accurately complete the Ancillary Provider ID Request Form.
- Press the ‘Get Form’ button to access the Ancillary Provider ID Request Form and open it in your preferred online editor.
- Begin by entering the date at the top of the form. This is important for documentation and processing.
- In the 'Attn' line, specify 'Facility Provider Services' to direct your submission to the correct department.
- Fill in the provided fax number for timely communication, which is 972-766-7315.
- Complete the 'Provider of Service Information' section with the corporate name as stated on line 1 of your W-9 form.
- Enter the physical address of your place of practice, including suite number if applicable, along with the city, county, state, and zip code.
- Provide the 'DBA Name' as listed on line 2 of your W-9 form, ensuring it matches your business entity.
- Indicate the type of facility, products, or services you offer, and include your contact phone number, fax number, and email address.
- Input your Medicare number and NPI (National Provider Identifier) as required for identification.
- Next, complete the 'Tax I.D Information' section by providing your Federal Tax Identification Number.
- In the 'Payee Address/Mail Check To' section, repeat the necessary address information ensuring it aligns with your mailing preferences.
- If applicable, complete the section regarding the Affiliate location by checking the relevant option and providing necessary details about the provider's status.
- At the end of the form, review your information for accuracy. After verifying, add your signature along with that of an authorized representative, and include your title and date of signing.
- Make sure to attach copies of the required documents, including your facility license, W-9 form, and NPI confirmation.
- Once all sections are complete and documents attached, save your changes, and download, print, or share the form as needed.
Complete your Ancillary Provider ID Request Form online today for efficient processing.
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What is the phone number for BCBS customer service in Texas?
Please call our customer service number at 1-888-697-0683 (TTY/TDD: 711) from 8:00 a.m. – 8:00 p.m., local time, 7 days a week.
What is the payer ID for BCBS Texas?
Plan health care providers submitting claims via the Availity Health Information Network must use payer identification code 84980. If you use another clearinghouse, please confirm that the correct electronic payer identifier for BCBSTX is used with your electronic claim vendor.
What is the phone number for BCBS Texas Blue Card provider?
BlueCard® Eligibility and Benefits Call 1-800-676-2583 for eligibility and benefits prior to services benefits prior to services being rendered.
How do I speak to a live person at BCBS of Texas?
Individual and Family Plans Under 65 Customer Service. 1-800-531-4456. Monday – Friday: 8 a.m. – 8 p.m. CT. Saturday: 8 a.m. – 6 p.m. CT. ... Under 65 Customer Service for Existing Members. 1-888-697-0683. Monday – Friday: 7 a.m. – 8 p.m. CT. ... Medicare Supplement Customer Services. 1-888-697-0683. Dental Indemnity USA. 1-800-820-9994.
How do I get a live rep at BCBSTX?
For customer service, call the toll-free number listed on your member ID card. PPO/POS/Indemnity Plans. 1-800-521-2227. ... HMO Blue Texas Plans. 1-877-299-2377. ... HealthSelectSM of Texas Consumer Directed HealthSelectSM 1-800-252-8039. ... Dental. 1-800-521-2227. BCBSTX Behavioral Health. ... Magellan Behavioral Health. ... Membership Department.
How do I talk to someone at BCBS Texas?
The Customer Advocate department is available at 1-888-657-6061 (TTY 711). We are open 8 a.m. to 5 p.m. Central Time, Monday through Friday.
What is the claim address for Blue Cross Blue Shield of Texas?
Helpful Contact Numbers Individual and Family PlansContact InformationBlue 365 Deals(855) 511-BLUEMembership AddressBlue Cross and Blue Shield of Texas Attn: Membership P.O. Box 660819 Dallas, TX 75266-0819Claims AddressBlue Cross and Blue Shield of Texas P.O. Box 660044 Dallas, TX 75266-004412 more rows
How do I file a claim with BCBS of Texas?
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.
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