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Welcome

Producers

Providers

Company InformationContact Us

Network Management Contact Us Form

Please allow 30 days to process your request. Do not submit duplicate requests.

For the following inquiries, please utilize the indicated links:

Contracting/Onboarding Inquiry – Professional providers only

Have you completed the Provider Onboarding Form?
Yes and need status on request: Complete Case Status Checker

No: Referring to Provider Onboarding Process

Request for Fee Schedule – Professional providers only

to request up to 20 codes AVAILABLE IMMEDIATELY

to request a fee schedule, please allow 30 days

Note – Dentists, please contact DNOA Provider Support

Claim Inquiry - Professional and Ancillary/Facility

Have you checked claim status?
No: Referring to Claim Status

Yes

Continue with form below. Provide the following in the message box below:

Document control number (DCN) (BCBSTX claim number)
Member ID Number
Patient Name
Date(s) of Service
Total Billed Amount
Plan
Additional information from your customer service outreach

All Other Inquiries - Professional and Ancillary/Facility

Complete the following form: * Indicates a required field

*National Provider Identifier (NPI) Number(s):

*Tax Identification Number:

*Provider Name:

*Primary Specialty:

*Address:

*City:

*State:

*Zip:

*Contact Name:

*Contact Phone Number:

*Contact Email:

Related to previous case?
Provide case number:

*Reason for Request: Demographic Changes –
Include in message area below:
Full Street Address
Phone
Fax
Email
Name of Provider(s) to be Updated
Termination Request –
Include in message area below:
Date of Termination
Name(s) of Terming Provider(s)
Contract Copy Request –
Other (specify in message area)

Message:

Home Legal and Privacy Non-Discrimination Notice

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
© Copyright Health Care Service Corporation. All Rights Reserved.

Complete the following form:	* Indicates a required field
*National Provider Identifier (NPI) Number(s):
*Tax Identification Number:
*Provider Name:
*Primary Specialty:
*Address:
*City:
*State:
*Zip:
*Contact Name:
*Contact Phone Number:
*Contact Email:
Related to previous case? Provide case number:
*Reason for Request:	Demographic Changes – Include in message area below: Full Street Address Phone Fax Email Name of Provider(s) to be Updated Termination Request – Include in message area below: Date of Termination Name(s) of Terming Provider(s) Contract Copy Request – Other (specify in message area)
Message: