Date: Attn: Facility Provider Services Fax #: 9727667315 ANCILLARY PROVIDER ID REQUEST FORM Blue Cross and Blue Shield of Texas (BCB STX)Email: TXFPS bcbstx.com Fax: 9727667315 Attn:.
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How to fill out the TX Blue Cross And Blue Shield Ancillary Provider ID Request Form online
Filling out the TX Blue Cross And Blue Shield Ancillary Provider ID Request Form online is a crucial step for providers seeking to establish an out-of-network provider ID. This guide outlines the necessary steps to ensure that your application is completed accurately and efficiently.
Follow the steps to successfully complete the Ancillary Provider ID request form.
- Click the 'Get Form' button to obtain the form and open it in your document editor.
- Begin by entering the date at the top of the form. This date is essential for processing your application.
- In the 'Attn' section, specify 'Facility Provider Services' to ensure that your form reaches the correct department.
- Fill out the provider of service information, including the corporate name, address of the physical location, 'DBA' name, city, county, and type of facility, product, or services offered.
- Provide your contact information, including phone number, fax number, email address, NPI, state, and zip code.
- Enter your Federal Tax ID number and specify the payee address where checks should be mailed.
- If applicable, complete the section for adding an affiliate location to a parent hospital, selecting whether the provider has been deemed ‘Provider Based Status’ and answering the associated questions.
- Ensure you review all information for accuracy. Sign and date the form where indicated to certify that the information provided is correct and complete.
- Attach the required documents, including the facility license, a signed and dated W-9 form, and NPI confirmation.
- Once you have completed the form and attached the necessary documents, save your changes, download, print, or share the form as needed.
Complete your TX Blue Cross And Blue Shield Ancillary Provider ID Request Form online today!
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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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