Behavioral Health Program Changes for Some Provider Networks

Starting June 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will administer behavioral health benefits for members enrolled in our Blue Essentials^SM, Blue Essentials Access^SM, Blue Premier^SM and Blue Premier Access^SM in place of the current behavioral health administrator, Magellan Healthcare®.

How Does This Affect Providers?
For dates of service beginning on or after June 1 for Blue Essentials and Blue Premier members:

• Eligibility, prior authorization and claims inquiries should be directed to BCBSTX. Please call the number on the member ID card.
• Behavioral health claims must be submitted to BCBSTX for reimbursement.
• To receive in-network benefits, the behavioral health provider must be contracted with the member’s Blue Essentials or Blue Premier provider networks.

How Does This Affect Members?
We will notify Blue Essentials and Blue Premier members before the transition date. Some members will receive new BCBSTX ID cards as part of this transition.

We do not expect member benefits to be affected by this change. However, services rendered by out-of-network providers may be denied, impacting the members’ cost share responsibilities. It’s important to use the Availity Provider Portal  or your preferred vendor to check eligibility and benefits for all members before rendering services. This will help you confirm coverage details and other important information, including prior authorization requirements.

For more information, see the Eligibility and Benefits and Behavioral Health Care Management Program sections of our provider website. Refer to the Network Participation page for details about joining our network.

Availity is a trademark of Availity, LLC, 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 provided by third party vendors such as Availity. If you have any questions about the products or services provided by the vendor, you should contact the vendor directly.

Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized/pre-notified 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, call the number on the member’s ID card.