Referral Submission Tips
Blue Cross and Blue Shield of Texas (BCBSTX) receives a significant volume of duplicate referrals. We want to reduce your administrative burden and process your referral in a timely and efficient manner. Below are referral submission tips to help streamline your process and improve turn-around times for referral determinations by BCBSTX.
- In-Network Referral Submissions – Confirm which specialists are in-network by leveraging Provider Finder® on the BCBSTX website and determine which in-network provider your member prefers to see. Then, submit the referral request through Availity® Authorization & Referrals* or by calling the authorization phone number on the back of the member’s card.
- Out-of-Network Referral Submission – When there is not an in-network provider available for the needed specialty, use Provider Finder to locate which out-of-network provider the member prefers to see. Submit one referral for the out-of-network specialist agreed upon by member via Availity or by calling the number on the back of their ID card
Please do not submit multiple in-network or out-of-network referrals for the same member referral specialty and service date. BCBSTX will no longer accept multiple/duplicate referrals. This causes an administrative burden for both providers and BCBSTX as well as promotes waste in sending multiple letters to every provider referral when the member will only utilize one referral for the service.
BCBSTX will communicate with the submitting provider within 5 business days for HMO and 15 calendar days for PPO, in one or more of the following ways:
- Referral status update through Availity portal
- Call from the utilization management team
- Fax or letter regarding the determination
*Submitting a referral request utilizing Availity is efficient, offers the ability to verify status of decisions and provides real time online 24/7 access status. Register on Availity to get timesaving access at no charge. If you need registration assistance, contact Availity Client Services at 1-800- 282-4548. If you are already a registered Availity user, you do not need to re-register.
Refer to Availity Authorizations & Referrals for information on how to access and submit requests. In addition, refer to the PPO and HMO provider manuals sections C, D, and E for information on submitting referral requests especially related to use of out-of-network providers.
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Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate or contract of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Texas (BCBSTX). BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by independent third-party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly