Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company · Health Care Service Corporation (HCSC) · NAIC 70670
Where to send the appeal
Verified addresses and inbound channels. We refresh on every release.
Response timeline
The clocks that matter. Miss them and you escalate to the state insurance commissioner.
Codes worth fighting
Based on outcome data across our payer corpus.
- CO-97
- CO-18
- CO-4
- CO-167
- CO-204
- PR-2
- CO-50
- CO-29
- CO-109
Modifier behavior
The denials this payer applies on modifier-bearing claims. The rebuttal language is part of the Denial OS letter generator and not published here.
Modifier 25
Significant, Separately Identifiable E/M ServiceBCBS-TX applies aggressive editing on modifier 25 same-day E/M billing across the Blue Choice PPO and HMO Blue Texas products; common denial under CO-4 with bundling rationale.
Modifier 59
Distinct Procedural ServiceFrequent denial on PT/OT and chiropractic same-day bundling under CO-97. BCBS-TX edits engine has historically been more aggressive on 59 than other Blues plans.
Modifier GP
Outpatient PT plan of careRequired for PT services; missing GP triggers automatic denial under CO-4 or CO-167.
Interest statute
The legal basis for charging interest when payment runs late.
Texas Insurance Code §1301.103 (45-day prompt-payment standard for clean claims under PPO products) / Texas Insurance Code Chapter 843 (HMO timelines) / 28 TAC §21.2807 (interest on late payments)
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