Standards and Requirements
The means by which Blue Cross and Blue Shield of Texas (BCBSTX) exchanges member data with providers will change dramatically over the next several years. The changes – upgrading ANSI v4010 to ANSI v5010 and ICD-9 to ICD-10 – are required by a new directive from the U.S. Department of Health and Human Services (HHS). That directive makes the same requirement of providers. Learn more.
Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines Millman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Learn more.
The Consolidated Appropriations Act (CAA) of 2021 and the Transparency in Coverage Final Rule will impact many of our members starting Jan. 1, 2022. As providers caring for our members, you may be impacted as well. Learn more .
Blue Cross and Blue Shield of Texas (BCBSTX) uses the BCBSTX Provider website to publish disclosure notices. The website allows BCBSTX to disclose changes in a timely and comprehensive manner. View all Disclosure Notices.
Medical Policies are based on scientific and medical research. They are often used as guidelines for coverage determinations in health care benefit programs. Explore Medical Policy drafts that are currently being considered .
For information regarding Federal Employee Program® (FEP®) Medical Policies or Federal Employee Program Service Benefit Plan Brochure, please go to https://www.fepblue.org/ .
This site contains the BCBSTX General Reimbursement Information including the provider manuals. A password is necessary to access certain information. View General Reimbursement Information.
On Jan. 16, 2009, the U.S. Department of Health and Human Services (HHS) released a final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition from ICD-9 code sets and adopt ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes. Learn more.
The BCBSTX Provider Manuals are reference tools for providers. These manuals provide detailed policies, procedures and requirements necessary for participation in the BCBSTX contracting provider networks. Learn more.
Medical Policies are based on research that provides evidence of scientific merit for a particular medical technology. In most cases, they are used as guidelines for coverage determinations in health care benefit programs. Explore more about Medical Policies .