Provider Tools

At Blue Cross and Blue Shield of Texas (BCBSTX), we are committed to providing support to physician practices. We've designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.

AvailityTM Eligibility and Benefits

It is important to verify membership and check coverage details for every patient at every visit, before you administer treatment.

To obtain fast, efficient, detailed benefits information for Blue Cross and Blue Shield members, you can use Availity's Eligibility and Benefits tool. This free online tool can provide you with co-payment, co-insurance, deductible, and other important information. Learn More.

Average Paid Differentials

The following average paid differentials have been posted to foster awareness regarding the general financial impact of facility or drug type preferences.  A physician often has freestanding facility options for select outpatient services or generic drug options in most drug classes.  The type of facility or drug may have a significant financial impact on the member, employer or payer. Learn More.

Behavioral Health Electronic Eligibility & Benefits

An eligibility and benefits inquiry should be completed for every patient at every visit to confirm membership, verify coverage and determine other important information, such as the patient's co-pay, co-insurance and deductible amounts. Learn More

Blue Distinction®

Find facilities recognized for expertise in bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery, and transplants on the Blue Distinction website.

Bridges to Excellence®

BCBSTX is licensed as a sponsor of the Bridges to Excellence (BTE) Diabetic Care Recognition program, Cardiac Care Recognition program and Asthma Recognition programs. Learn More.

Claim Encounter Reconciliation Application (CERA)

The Claims Encounter Reconciliation Application (CERA) via Availity® helps providers manage and respond to Blue Cross and Blue Shield of Texas (BCBSTX) if potential coding opportunities are identified based on claims data, for members with on and off marketplace health plans. Learn More.

Claim Inquiry Resolution (CIR) Tool

Our Claim Inquiry Resolution tool is available via a tab in our Electronic Refund Management (eRM) system.  By providing a method for online assistance with specific inquiries on finalized claims, the CIR tool can help save your staff time by reducing the need for phone calls and written correspondence. Learn More

Claim Research Tool (CRT)

The Claim Research Tool (CRT) offers enhanced, real-time claim status functionality to help you manage and resolve your BCBSTX claims. Learn More

Clear Claim Connection™

Clear Claim Connection (C3) is a web-based code auditing tool, designed by McKesson Information Solutions, Inc., that enables BCBSTX to disclose our claim auditing rules and clinical rationale to our contracting provider network. C3 "mirrors" how BCBSTX's current code auditing software evaluates code combinations during the adjudication of a claim. Learn More

Clinical Quality Validation (CQV) Application

Clinical Quality Validation (CQV) is a web-based application in the Availity® Provider Portal that allows providers to quickly comply with Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Providers can electronically document their patient’s care and assessments to close quality HEDIS care gaps for BCBSTX members using CQV. Learn More


CoverMyMeds is an online tool for electronic completion and submission of benefit prior authorization (PA) requests for prescription drugs that are part of the Blue Cross and Blue Shield of Texas (BCBSTX) pharmacy PA program. Learn More

DNoA Connect

DNoA Connect Learn more about third-party links is a provider self-service tool where dental offices can conveniently connect to patient information for members with BlueCare DentalSM. It was designed to help providers manage their administrative tasks as quickly and efficiently as possible. Learn More

Electronic Quality and Risk Adjustment Medical Records Requests

The Availity® Medical Attachment tool allows providers to receive electronic quality and risk adjustment medical record requests from Blue Cross and Blue Shield of Texas (BCBSTX). Learn More

Electronic Refund Management (eRM)

Electronic Refund Management (eRM) is an online tool that can help simplify your overpayment reconciliation and related processes. Learn More

Eligibility and Benefits Inquiry (HIPAA 270/271)

An eligibility and benefits inquiry should be completed for every patient at every visit to confirm membership, verify coverage and determine other important information, such as the patient's co-pay, co-insurance and deductible amounts. Learn More


iExchange is a web-based application that supports the direct submission and processing of referrals and approval of select outpatient services and inpatient admissions to acute care facilities by network physicians, professional providers and facilities within Texas. Learn More

OptiNet®' Assessment Tool

OptiNet is an online assessment tool developed by AIM Specialty Health®' (AIM)'  to collect modality-specific data from imaging providers. This tool is as an enhancement to our Radiology Quality Initiative (RQI) program, which AIM®' administers for BCBSTX. Learn More

Patient Care Summary

The Patient Care Summary tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. This electronic health record can help you identify gaps in care, missed prescription refills and possible drug interactions, and other "clinical flags" and treatment opportunities. Learn More.

Patient Cost Estimator

The Patient Cost Estimator is a member liability estimator tool. This free online tool can provide you with a real-time, estimated member share amount at the time of service, while the patient is still in your office, prior to claim submission. Learn More.

Remittance Viewer

The remittance viewer offers providers and billing services a convenient way to view and help reconcile claim data provided by Blue Cross and Blue Shield of Texas (BCBSTX) in the 835 Electronic Remittance Advice (ERA). Learn More

Reporting On-Demand

The Reporting On-Demand application allows users to readily view, download, save and/or print the Provider Claim Summary (PCS) and other reports online, at no additional cost. Learn more.

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