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Bcbstx claim review form

Bcbstx claim review form 2026

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The document is a Claim Review Form used for submitting requests to Blue Cross and Blue Shield of Texas for the review of previously adjudicated claims. It requires detailed information about the claim, including member and provider data, reasons for the review, and supporting documentation. The form must be completed accurately to facilitate the review process, and it outlines specific instructions on what to include and how to submit the form.

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Click ‘Get Form’ to open the bcbstx claim review form in the editor.
Begin by filling in the required fields under 'claim data'. Enter your Group Number, Today's Date, Member’s Identification Number, and both Member’s and Patient’s Names.
Provide the Date(s) of Service and Billed Amount. Make sure to include the DCN (Claim Number) assigned by BCBS, noting that you should not resubmit unless corrections are made.
Select the type of review by checking one of the options provided. This includes Additional Information requested by BCBS, Claim Review, Medical Records, or ClaimCheck®/ClaimsXtenTM.
Fill in your Provider Name, NPI Number, City, Billing Address, State, Email Address, Fax Number, Contact Person, Zip Code, and Phone Number.
Ensure all required information is complete before submitting. Remember to include any necessary supporting documentation for a smooth review process.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to submit a corrected claim to BCBS of Texas?

File electronically, as usual. File the claim in its entirety, including all services for which you are requesting reconsideration. BCBSTX will adjust the original claim. The corrections submitted represent a complete replacement of the previously processed claim.

How to submit a corrected medical claim?

Corrected Claim Submission: EDI Claims Corrections can be sent in an electronic format. On the CMS-1500 Form, use Corrected Claim Indicator (Medicaid Resubmission Code). Enter the frequency code 7 in the Code field and the original claim number in the Original Ref No. field.

Does BCBS of Texas require prior authorization?

Sometimes, you may need to get approval from Blue Cross and Blue Shield of Texas before we cover certain health care services and prescription drugs. This is called prior authorization, sometimes called prior authorization, preauthorization, pre-certification or prior approval.

How do I correct a claim with Blue Shield?

To correct a claim, re-submit it electronically. To avoid having the claim denied as a duplicate, wait for the original claim to be finalized before sending as a corrected claim. Be sure to indicate that it is a corrected claim. All claim corrections must be received within your contracts timely filing period.

What is the resubmission code to submit a corrected claim?

If you are submitting a void/replacement paper CMS 1500 claim, please complete box 22. For replacement or corrected claim enter resubmission code 7 in the left side of item 22 and enter the original claim number of the claim you are replacing in the right side of item 22.

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How do I appeal a BCBS of Texas claim?

File a written appeal using the Health Plan Appeal Request Form. Mail or fax it to us using the address or fax number listed at the top of the form. File an oral appeal by calling the BCBSTX Customer Advocate Department toll-free at 1-888-657-6061 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m., Central Time.

What time can I call BCBS Texas?

Monday Friday: 8 a.m. to 5 p.m. CT.