Health Care Service Corporation (HCSC) - BCBS IL/TX/OK/NM/MT

Denials, appeals and grievances

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appeals grievances

BCBSTX Blue Essentials — Medical Management appeals

Official page read

Phone855-896-2701Fax

866-221-3607

Appeals of adverse determinations for medical necessity or experimental/investigational services under section 7 of the HMO manual.

Published hours

Not published in this record

Product, plan and location

commercial
Texas

Mailing address

BCBSTX Medical Management, Attention: Appeals Department, 1001 E. Lookout Dr., Richardson, TX 75082-4144

Medical-necessity or experimental/investigational adverse-determination appeals.

The current HMO manual places this phone and fax under Medical Management appeals. BCBSTX-managed initial prior authorization and recommended clinical review use a separate published phone or the member ID-card number. Out-of-network and non-covered-benefit complaints have separate customer-service instructions. Providers subject to capitated medical-group procedures must follow that group’s instructions.

View source ↗ · Source checked 2026-10-22 · Source updated 2025-10-05 · bcbstx current hmo manual index ↗

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Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.

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Denial notice, remittance and reason codes
Previous appeal confirmation and decision
Supporting evidence and any required authorization to represent the member

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