May 2017

Benefit Information Accessible in the IVR Phone System

The Blue Cross and Blue Shield of Texas (BCBSTX) Interactive Voice Response (IVR) phone system provides access to some of the same patient eligibility and benefits information that a Customer Advocate provides. As a result, on Dec. 12, 2016, Customer Advocate assistance was removed for several common benefit categories that are available through IVR. Remain assured that our Advocates will continue to be available for more complex benefit quotes.

BCBSTX is committed to providing efficient and secure access to patient information. To better assist providers with understanding the recent IVR change, see the list of the benefit categories addressed in the IVR below (including a separate list for Federal Employee Program [FEP] members). This list is continually reviewed and may vary across our different BCBSTX networks, products and/or group policies.

IVR Contained Benefit Categories
Office Visit	Hospital	Preventive Care
Colonoscopy	Allergy	Ultrasound
Coordinated Home Care	Laboratory	X-ray
Extended Care Facility	Mammogram	EKG
Physical Exam	Inhalation Therapy	Consultations
Pap Smear	Private Duty Nursing	Office Services

FEP IVR Contained Benefit Categories
Accidental Injury	Maternity
Allergy	Office Visit
Chiropractic Services	Outpatient Physical, Occupational and Speech Therapy
Diagnostic – Lab, X-ray, Outpatient Diagnostic	Vision
Inpatient Benefits – Inpatient Hospital, Inpatient Surgery

Regardless if you are navigating the IVR to determine patient coverage or talking with a Customer Advocate to request pre-determination of benefits status, it is imperative that you select the exact benefit category that will be rendered for the patient. This will ensure you receive the most accurate benefit information associated with your request.

Checking eligibility and benefits electronically through Availity^TM or your preferred web vendor is the quickest way to access information for BCBSTX members. To learn more about online solutions, refer to the Provider Tools page on our website. For IVR navigational assistance, refer to this handy Eligibility and Benefit Caller Guide.

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.