Notices and Announcments

Women’s contraceptive drug list reminder
Under the Affordable Care Act, certain U.S. Food and Drug Administration approved women’s contraceptives are covered with no member cost share when in-network providers and pharmacies are used. The list of women's contraceptives covered by Blue Cross and Blue Shield of Texas (BCBSTX) for eligible benefit plans was updated this year to include dosage strengths for some drugs.

Eligible members with prescription drug coverage through Prime Therapeutics may find the Women’s Contraceptive Drug List in the Member Services/Prescription Drug Plan section of the BCBSTX member website. If members have questions, they may contact the number on the back of their ID card for assistance.

Prime Therapeutics LLC is a pharmacy benefit management company. BCBSTX contracts with Prime to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSTX, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.

Claim status availability to change in automated phone system
Effective Monday, July 13, claim status requests will no longer be available within the BCBSTX Interactive Voice Response (IVR) phone system. You may continue to use the IVR phone system to obtain eligibility and benefits information and Customer Advocates will remain available for other inquiries, such as claim adjustments.

Electronic transactions are available to help you streamline administrative processes and minimize time spent by your staff on unnecessary phone calls. You will need to direct claim status requests electronically through your Web vendor of choice. The Availity^TM Claim Research Tool provides enhanced claim status at no cost by going to availity.com.

Additional information regarding the above-referenced change will be published in upcoming issues of Blue Review as well as on our provider website.

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, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.

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 independent 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.