Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

November 2016

Obtaining Patient Eligibility and Benefits: Phone System Update

Several benefit categories have been authenticated in the Interactive Voice Response (IVR) phone system. This validation supports a complete IVR quote of eligibility and benefits, with the same level of information a Customer Advocate would provide. For this reason, the option for Customer Advocate assistance has been removed from the call flow for common benefit categories.

Verification of patient information is strongly encouraged prior to every scheduled appointment and having quick access to this data is imperative. The fastest way to obtain patients’ eligibility and benefit information is electronically through Availity®, or your preferred Web vendor. Taking advantage of electronic options allows retrieval of needed information in real-time.  

If eligibility and benefits are unable to be verified online, the same information is readily accessible through our IVR. A confirmation number will be provided for your records, after the phone system has completed the quote. 

For more information, refer to the Claims and Eligibility/Eligibility and Benefits section of our website at bcbstx.com/provider. This section includes an Availity Eligibility and Benefits Tip Sheet, as well as other related resources to assist you with electronic transactions. For assistance with verification via phone, refer to the Eligibility and Benefits IVR Caller Guide, found in Claims and Eligibility/IVR system section.

Checking eligibility and/or benefit information 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 of coverage applicable on the date services were rendered. If you have any questions, please call the number on the back of the member’s ID card.

Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.