Marlien · Payer guide
Blue Cross Blue Shield of Texas
Health Care Service Corporation — Blue Cross Blue Shield of Texas
- TX
- Commercial
- Medicare Advantage (exits all Blue-branded MA for 2027)
- STAR
- STAR Kids
- CHIP
Where you file
- How you apply
- CAQH Provider Data Portal — mandatory for CAQH-approved provider types
- The path
- Alternative for non-CAQH-approved types: TDI standardized credentialing application. Facilities: Availity.
- What access you need
- Start with the Provider Onboarding Form, then review the TX Initial Credentialing Checklist before filing.
- Who verifies
- Verisys (formerly Aperture) — Centralized Verification Organization
- Worth knowing
- Verisys performs PSV, notifies the provider, and assigns the newly created common re-credentialing date.
CAQH
- Required
- Physicians and other professional providers MUST use CAQH for initial credentialing and re-credentialing.
- Authorise this payer
- Blue Cross Blue Shield of Texas — global or plan-specific
Lines of business
Each line is its own application, with its own checklist, its own effective date and its own contract. Filing one does not file the others. What follows is what this payer asks for, line by line.
Commercial
Blue Cross Blue Shield of Texas commercial book. A separate licensee from Blue Cross Blue Shield of Georgia — no file transfer.
Medicare Advantage (MA)Medicare Advantage
Blue-branded MA ends for the 2027 plan year (group retiree plans continue). HealthSpring is the surviving HCSC MA brand.
Medicaid — STAR / STAR Kids / CHIP
TMHP Medicaid enrollment is a hard prerequisite. Additional state and MCO requirements sit on top of the professional credentialing file.
What the payer publishes about time
- Completeness review
- 8–10 calendar days (review only, on average)
- Decision
- Credentialing Committee; Medical Advisory Committee meets regularly or as needed
- Committee
- regularly scheduled meetings, or as needed
- Contract
- notVerified
- What the numbers mean
- Total elapsed to a billable provider number routinely runs 2–4× the published completeness figure.
Deadlines that start a clock
Finalize CAQH or the process is discontinued and you start over45 calendar days
counted from the date we submitted
Correct erroneous or conflicting information (flagged in writing)30 calendar days
counted from the date we received the deficiency notice
File a written appeal with the Credentialing Committee10 calendar days
counted from the payer's decision
Recredentialing
- Cycle
- Driven by the Verisys-assigned common date
- What it hangs on
- Verisys
- Worth knowing
- Verisys notifies providers, including the newly assigned common re-credentialing date.
The effective date
Approval is not the date. These are the markers that make a date real.
- How it is established
- Assigned at the completion of onboarding activities; the provider's network effective date may differ from the contract effective date.
- What proves it
- Network effective date letter
- Contract date
- This is not the same as the contract effective date. Track both.
- Worth knowing
- THE NETWORK EFFECTIVE DATE MAY DIFFER FROM THE CONTRACT EFFECTIVE DATE. Track both. Contract effective date is not the date you bill from. A Provider Record ID alone does NOT activate the network — claims process out-of-network until the provider is approved and activated.
Backdating: 30 days
42 CFR 424.521(a)(1) — retrospective billing is permitted for up to 30 days before the effective date ONLY where circumstances precluded enrollment in advance of providing services, and only for services provided at the ENROLLED PRACTICE LOCATION. 90 days is available where a Presidentially-declared Stafford Act disaster precluded advance enrollment. It is a DETERMINATION, not an entitlement.
Federal rule, not confirmed in BCBSTX's own MA material. Blue-branded Texas MA exits for the 2027 plan year — do not sell a 2027 Blue-branded MA filing.
This is a federal rule. This payer's own material does not confirm it, so we do not promise it. We tell the payer what the circumstances were and let the payer decide.
What we checked, and what we did not
Channel, Provider Onboarding Form path, CAQH mandate and the 45-day finalization deadline, 8–10 day completeness review, 30-day cure window, 10-day appeal, Verisys CVO, 90-day ancillary, the four-point EXPEDITED PROVISIONAL-PARTICIPATION CRITERIA, TMHP prerequisite, office-based provider-type list and every link above confirmed 2026-11-02.
The payer's own pages
Where to file
- Provider Onboarding Form — How to Join Our Networks (START HERE)Providers › Network Participation › How to Join › Provider Onboarding ProcessYou will be assigned a BCBSTX Provider Record ID for each Tax ID you bill under, and the agreements are sent to you after you choose in-network participation. You cannot save the form and return — it times out after 30 minutes.
- CAQH Provider Data Portal — authorize BCBSTXProView › Authorization tab › global or plan-specific authorization to Blue Cross Blue Shield of TexasFinalize within 45 days or the BCBSTX credentialing process is discontinued and you start over.
- TDI Texas Standardized Credentialing Application — non-CAQH provider typesComplete the TDI application, then fax to 972-996-8230 (preferred) or mail to: Blue Cross and Blue Shield of Texas, Attn: Enterprise Credentialing, PO Box 65067, Dallas, TX 75265-0267Attach: state license(s), DEA certificate, malpractice face sheet, malpractice case summary (10 years or less), CV, signed attestation (page 18), written protocol (NPs only).
- Medicaid (STAR / CHIP / STAR Kids) — TX Medicaid Network DepartmentFax 1-512-349-4853 or mail to: Blue Cross and Blue Shield of Texas, 9442 II Capital Texas Highway North, Suite 500, Arboretum Plaza IIYou must be enrolled as a Medicaid provider with TMHP before you can be credentialed into STAR/CHIP/STAR Kids.
Information and forms
- Credentialing process — office-based physicians and professional providersTHE source for the expedited provisional-participation criteria and the 8–10 day completeness review.
- TX Initial Credentialing Checklist (PDF)Review before submitting. Catches most incomplete files.
- Types of Professional Providers Requiring Credentialing (PDF)An applicant in a training program is NOT eligible for network participation.
- CAQH Approved Provider Types List (PDF)If your type is not on this list, use the TDI application instead.
- TX Office-Based Provider Facility Admitting Privileges Requirements List (PDF)Some specialties that do procedures in a facility must hold privileges at an in-network facility.
- Facility Coverage Letter (PDF)May substitute for privileges where the privileges list allows it. Must be submitted with the onboarding application.
- Case and Credentialing Status CheckersCase number from the onboarding confirmation email, or NPI / license number.
- TX Medicaid STAR / CHIP / STAR Kids provider manual 2025 (PDF)Full STAR/CHIP/STAR Kids rules including the expedited criteria.
- CAQH Credentialing FAQ (PDF)Answers to the recurring CAQH questions.
- Getting started with CAQH (PDF)
- Web Demographic Change FormFor changing demographics on an existing contract — not for new enrollment.
Who to contact
- Enterprise Credentialing — incomplete applicationsIncomplete or non-CAQH application packetsIncompleteCredentialingApplication@bcbstx.com
- Texas Medicaid Network DepartmentSTAR / CHIP / STAR Kids credentialing questionsTexasMedicaidNetworkDepartment@bcbstx.com
- BCBSTX behavioral health — MagellanBehavioral health credentialing for STAR / CHIP800-788-4005STAR Kids behavioral health: 1-877-784-6802.
- BCBSTX Provider Customer ServiceSTAR and CHIP behavioral health1-877-560-8055
- Network Management ConsultantYour named BCBSTX contactAssigned after the Provider Onboarding Form is processed. Not published — request your assignment.
- BCBSTX provider contact pageNetwork Management Office locations and fax numbers