A claim is a request for payment from Blue Cross Blue Shield of Texas for the medical or mental health services you get. Normally these are submitted by your provider but in certain situations such as when you get out-of-network services or services overseas, you may need to pay up front and file the claim to Blue Cross and Blue Shield of Texas (BCBSTX) yourself.
When you get services from a non-network provider, you have 18 months from the date of service to submit a claim to BCBSTX for possible reimbursement of your covered health services. If you submit your claim more than 18 months after the date of service, your claim will be denied, and benefits will not be paid to you or your provider.
When your health care claim has been processed, you will get an Explanation of Benefits (EOB) or a claims letter. You get an EOB when HealthSelect is pays first — before any other insurance plan pays for the services you get. A claims letter is used when HealthSelect is the secondary or third payer.
How to submit an out-of-network domestic claim
When you get care from in-network providers, they submit claims to BCBSTX for you. If you see an out-of-network provider, you may need to submit claims yourself for reimbursement.
Out-of-network claims for both medical and mental health services can be submitted through your Blue Access for Members participant portal:
- After logging in, from the Home tab you will see ‘Message Center’ on the left.
- Click on ‘View all messages.'
- Then on the next screen click ‘Create a New Message’ and begin typing your message.
- Use the ‘Add Attachment’ button to upload your claim form and an itemized bill showing the services you got.
For detailed submission instructions, see this guide.
You can also submit both medical and mental health claims by mail to:
Blue Cross and Blue Shield of Texas - Claims
PO Box 660044
Dallas, TX 75266-0044
Note: For mental health claims for services prior to September 1, 2020, under the HealthSelect of Texas® and Consumer Directed HealthSelectSM plans, send the Magellan Claims Form to:
Magellan Health Services
PO Box 1289
Maryland Heights, MO 63043
How to submit an international claim
You can submit your completed international claim form and documentation using one of the following methods:
P.O. Box 2048
Southeastern, PA 19399
Online: at www.bcbsglobalcore.com
By email: email@example.com
- Medical and Mental Health Claim Form | (Mental health services for HealthSelect of Texas and Consumer Directed HealthSelect: Use this form only for services after September 1, 2020)
- Magellan Mental Health Claim Form | (Mental health services for HealthSelect of Texas and Consumer Directed HealthSelect: Use this form for services before September 1, 2020)
- International Claim Form