June 2017

Additional Benefit Categories Contained in IVR Phone System Beginning June 19

Our May 2017 Blue Review included a list of common benefit categories contained within the Blue Cross and Blue Shield of Texas (BCBSTX) Interactive Voice Response (IVR) phone system. Beginning June 19, 2017, the list will be expanded to include additional common benefit categories.

The IVR quotes the same level of eligibility and benefit information that a Customer Advocate provides. Our Customer Advocates will continue to be available for more complex benefit quotes.

To help ensure provider readiness, an updated IVR benefit containment list is below. This list outlines those categories that were effective on Dec. 12, 2016, along with the additional categories to be implemented June 19, 2017.

As a reminder, this information is continually reviewed and may vary across different BCBSTX networks, products and/or group policies. There are no other benefit categories being added to the Federal Employee Program (FEP) IVR Contained Benefits list at this time. To view the separate containment list for FEP members, refer to the May 2017 Blue Review article.

IVR Contained Benefit Categories Effective Dec. 12, 2016	Additional IVR Contained Benefit Categories Effective June 19, 2017
Allergy Colonoscopy Consultations Coordinated Home Care Electrocardiogram (EKG) Extended Care Facility Hospital Inhalation Therapy Laboratory Mammogram Office Services Office Visit Pap Smear Physical Exam Preventive Care Private Duty Nursing Ultrasound X-ray	23-hour Observation Air Ambulance Anesthesia Assistant Surgeon CAT Scan Dialysis Ground Ambulance Hospice Medical Supplies MRI Pathology PET Scan Prosthetics Prostate-specific Antigen (PSA) Sterilization

Note: The above listings are not applicable to Blue Cross Medicare Advantage (PPO)^SM or Blue Cross Medicare Advantage (HMO)^SM government program member policies. For eligibility and benefits for these government programs via phone, refer to the number on the member’s BCBSTX identification card.

As a reminder, checking eligibility and benefits electronically through Availity^TM or your preferred web vendor is the quickest way to access BCBSTX member information. To learn more about online solutions, see the Provider Tools section of the BCBSTX provider website.

Checking eligibility, benefit information and/or if 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 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.