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Provider Tools

At BCBSTX, we are committed to providing support to physician practices. We’ve designed tools that health care providers find useful. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more.

Average Paid Differentials

The following average paid differentials have been posted to foster awareness regarding the general financial impact of facility or drug type preferences. A physician often has freestanding facility options for select outpatient services or generic drug options in most drug classes. The type of facility or drug may have significant financial impact on the member, employer or payer. Learn More.

Be Smart. Be Well.^TM

Be Smart. Be Well.^TM, a wellness website.

Behavioral Health Electronic Eligiblity & Benefits Customized Training

An eligibility and benefits inquiry should be completed for every patient at every visit to confirm membership, verify coverage and determine other important information, such as the patient's co-pay, co-insurance and deductible amounts. Learn More

Blue Distinction

Blue Cross Blue Shield of Texas, in partnership with the Blue Cross and Blue Shield Association, has developed Blue Distinction Centers. Each Center has been selected through a rigorous evaluation of clinical data that provides insight into the facility's structures, processes and outcomes of care. These nationally established criteria were developed with input from medical experts and organizations and support the consistent, objective assessment of specialty care capabilities. Learn More

Bridges to Excellence

Blue Cross and Blue Shield of Texas (BCBSTX) is licensed as a sponsor of the Bridges to Excellence^® (BTE) Diabetic Care Recognition program and Cardiac Care Recognition programs. Learn More.

CareCost Estimator

The CareCost Estimator is a member liability estimator tool. This free online tool can provide you with a real-time, estimated member share amount at the time of service, while the patient is still in your office, prior to claim submission. Learn More.

CareProfile®

The CareProfile tool uses claim-based information to provide you with a consolidated view of a patient's health care history at the point of care. This electronic health record can help you identify gaps in care, missed prescription refills and possible drug interactions, and other "clinical flags" and treatment opportunities. Learn More.

Claim Inquiry Resolution (CIR) Tool

Our Claim Inquiry Resolution tool is available via a tab in our Electronic Refund Management (eRM) system. By providing a method for online assistance with specific inquiries on finalized claims, the CIR tool can help save your staff time by reducing the need for phone calls and written correspondence. Learn More

Claim Research Tool (CRT)

The Claim Research Tool—CRT— offers enhanced, real-time claim status functionality to help you manage and resolve your BCBSTX claims. Learn More

Clear Claim Connection

Clear Claim Connection™ (C3) as a web-based code auditing reference tool. C3 is an online code auditing tool, designed by McKesson Information Solutions, Inc., that enables BCBSTX to disclose our claim auditing rules and clinical rationale to our contracting provider network. C3 "mirrors" how BCBSTX’s current code auditing software evaluates code combinations during the adjudication of a claim. Learn More

Electronic Provider Tools Reference Guide

Blue Cross and Blue Shield of Texas has prepared a reference guide to help you understand the electronic online tools available. These online tools can help streamline your workflow by providing fast and secure access to information. Learn More

Electronic Refund Management (eRM)

Electronic Refund Management (eRM) is an online tool that can help simplify your overpayment reconciliation and related processes. Learn More

Eligibility and Benefits Inquiry (HIPAA 270/271)

iEXCHANGE

iEXCHANGE is a Web-based application that supports an automated precertification process for Blue Cross and Blue Shield of Texas (BCBSTX). iEXCHANGE supports the direct submission and processing precertifications by facilities within Texas. Learn More

Obesity Management Tool Kit Web Site

OptiNet_®' Assessment Tool

OptiNet is an online assessment tool developed by AIM Specialty Health to collect modality-specific data from imaging providers. This tool is as an enhancement to our Radiology Quality Initiative (RQI) program, which AIM_®' administers for BCBSTX. Learn More