BCBS Provider Phone Number. Tennessee. We are now processing credentialing applications submitted on or before March 14, 2023. When dependent children are double-covered by divorced parents, coverage depends on any court decrees. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. 0000004602 00000 n Please treat these members the same as domestic Blue Plan members. In box 22 on the CMS-1500 Claim form, enter the appropriate bill frequency code, left justified in the left hand side of the field. Supplier Registration If the member does not return the IQ within the specified timeframe, we'll deny all related claim(s). Always use the alpha prefix on the members current ID card. Examples: medical doctor, osteopath, optometrist, chiropractor, physical therapist, audiologist, independent laboratory, nurse practitioner, durable you will need to contact Regence to update your account to ensure your claim processes correctly and timely. Note: Some members will remain in Blue Cross of Northeastern Pennsylvania health plans until their coverage renews to Highmark health plans later this year. If you have questions, please contact your local Blue Cross and Blue Shield company. Media Contact: Lou Riepl Regence BlueCross BlueShield of Utah Regence BlueShield of . We use cookies on this website to give you the best experience and measure website usage. ** Make copies of the front and back of the members ID card and pass this key information on to your billing staff. Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. ADI Anthem Blue Cross of California The Federal Employee Program (FEP) NO LONGER uses the address below, and mail will discontinue to be forwarded to the correct address above. There is other activity on your account during the payment cycle. account number and claim number handy when you call. ABN Anthem BCBS of Virginia Member identification prefixes were updated as part of that transition. Portugus | Management - prior auth/pre-service requests), Members: Log in or register - MyBlue Customer eService, Retail Pharmacy Program PO Box 52057 Phoenix, AZ 85072, Retail Pharmacy Program PO Box 52080 Phoenix, AZ 85072, Phone:800-552-0733Fax: 801-333-6523 (Mark claims: Attn New Claims)Email: Log in or register - MyBlue Customer eService, Regence BlueShield - FEPPO Box 857Lewiston, ID 83501, Regence BlueShield - FEPPO Box 1388Lewiston, ID 83501Customer Service. AAX Anthem Blue Cross of California treatment center. ARH IN BCBS of Indiana, POB 68416, Accordia NW , Indianapolis , IN , 46268 317-488-6000, ARR OH BC OH Anthem, 4361 Irwin Simpson Rd , Mason , OH , 45040 513-872-8100, ASA Indemnity CNY PO Box 4809 , Syracuse , NY , 13221 315-448-3735, ASH WNY BCBS WNY, Auto Natl Accts, POB 757 , Buffalo , NY , 14240-0757 800-462-7237, AST TN BCBS Of Tennessee, 801 Pine St , Chattanooga , TN , 37402 423-755-5600, ATT Empire Empire BC, POB 5020 , Middletown , NY , 10940 800-772-2875, AWR PA PA BS Highmark, POB 535045 , Pittsburgh , PA , 15253-5045 800-294-2217, AZO IL BC IL, POB 1364 , Chicago , IL , 60690-1364 800-637-6917, BAN WV BC Washington DC/Carefirst, 550 12th St SW , Washington , DC , 20065 800-642-2411, BBH PPO GA BCBS GA, POB 9907 , Columbus , GA , 31908 800-628-3988, BDC MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237 0000015026 00000 n AFK Empire BCBS They require completion and mailing of an Incident Questionnaire for possible accident investigation or a Workers Compensation injury (claims in subrogation). ** Do not change the sequence of the characters following the alpha prefix. Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. If you get the plan specific alpha prefix, then the first two characters in this prefix are used to identify your plan. To contact us without setting your ZIP code, call: Prescription questions?Call Customer Service and choose the Pharmacy option. In some contracts, we use a RBRVS methodology, developed by CMS, to calculate its fee-for-service fee schedule. How do I identify international members? When members from Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. QME Retail OFF Exchange Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. QMB SG ON Exchange YDW Retail OFF Exchange For information that cannot be served by Availity Essentials or our self-service tool, our Provider Contact Center is available Monday through Friday, 6 a.m. - 5 p.m. (PT). Is distinct from our medical policy, which sets forth whether a procedure is medically necessary/appropriate, investigational or experimental and whether treatment is appropriate for the condition treated. Any suggestions. Please request a current ID card from the member. In this health insurance plan, alpha prefix is assigned to national accounts. Insurance Denial Claim Appeal Guidelines. BET PA BC PA, 120 Fifth Ave , Pittsburgh , PA , 15222-3099 412-544-7000, BFM PA BC PA Highmark, POB 176 , Pittsburgh , PA , 15230-0176 866-316-6339, BGH AL BCBS of Alabama, POB 995 , Birmingham , AL , 35298 205-988-2213, BGP MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BHP PA BC PA, POB 778988 , Harrisburg , PA , 17177-8988 800-222-3341, BIM MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BMI IN BCBS of Indiana, 120 Monument Circle , Indianapolis , IN , 46204 317-488-6000, BOG MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237 Claims and clinical appeals address: PO Box 21702 Eagan, MN 55121 Care management Phone: 844-996-0329 Fax: 888-302-9325 2023 holiday closures January 2 May 29 July 4 September 4 November 23 November 24 December 25 Prefix State/Area Plan Type Plan Name Provider and member service CMS contract, VOF NY MA HMO MediBlue HMO 1-800-499-9554 H3370 CYJ Horizon BCBS of New Jersey Polski | An overpayment was recorded during the payment cycle. There is no charge to healthcare providers who submit electronic claims directly to us. Applicable to facility claims only - reflects the APG code, DRG code, or room type that may relate to the reimbursement amounts. BCBS Provider Phone Number. AFG BCBS of Nebraska Premera Blue Cross Blue Shield of Alaska FEP PO Box 33932 Seattle, WA 98133-0932, Phone:800-562-1011 CZJ Premera Blue Cross of Washington ACX BCBS of IL Italiano | | Physicians and other healthcare providers receive an Explanation of Payment (EOP), which describes our determination of the payment for services. The provider appeals process does not apply to FEP, BlueCard Home Claims, Medicare Supplement plans, or Medicare Advantage plans. Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. A non-billing issue is classified as a member appeal because the financial liability is that of the member, not the provider (please refer to Chapter 6). . ADY BCBS of South Carolina AAB BCBS of Michigan Bill all original lines-not including all of the original lines will cause the claim to be rejected. All Rights Reserved to AMA. They have Coordination of Benefits when we are the secondary carrier on the claim. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. CMS also uses RVUs to allocate dollar values to each CPT or HCPCS code. Payment of this claim depended on our review of information from the provider. Members and Providers: 1-800-395-1616 Email Us. This plan allows you to self-refer. Chronic Obstructive Pulmonary Disease. CNK-HR-0230 398-0520-PN-NY. CWN Carefirst BCBS Washington DC ACV BCBS of Georgia Provider: please send us the member's lab results for this claim. Blue Cross and Blue Shield of Illinois P.O. Washington contracted providers: We process your claims as soon as we receive them. Coronary Artery Disease. Here's everything you . | A fragmented or split professional billing is defined as professional services rendered by the same provider for the same date of service and submitted on multiple professional claim forms. Below is a list of the old and new alpha prefix codes. Once the claim is found, you can click on original EOP view to pull up this information. When processing claims, the system: Actual payment is subject to our fee schedule and payment policies; to a members eligibility, coverage, and benefit limits at the time of service; and to claims adjudication edits common to the industry. Medical claims. DAD Anthem BCBS of Ohio Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. The three characters preceding the subscriber identification number on BCBS member ID cards. ACU Anthem Blue Cross of California Provider Contact Center. AHQ Anthem BCBS of Ohio Carpenters Retirement Plan Individual Account Pension Plan Pre-Retirement Planning Your Balances & Accruals. | Calypso, our affiliate, processes refunds and overpayment requests. 0000004829 00000 n P.O. National Correct Coding Initiative (NCCI) editing is followed when applicable. Box 7408. (BlueCard will request refunds regardless of the dollar amount.) Need help with a claim? $25 will continue to accrue until it reaches that threshold or until December of each year. AGT Blue Shield of California ABA BCBS of IL 10/18) v2. 0000012556 00000 n The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. ADD Anthem BCBS of Ohio 0000014071 00000 n We require that you verify the information about your practice and the networks you participate in at least every 90 days. color, national origin, age, disability, sex, gender identity, or sexual orientation. We use an automated processing system to adjudicate claims. All of our contracts exclude coverage for care covered under the Workers' Compensation Act. Alaska contracted and non-contracted 0000008944 00000 n P | Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. Policy #s: Regular 10017241-0001, Transit 10017241-0004, Sheriff 10017241-0016 . . Your Claims & Eligibility. To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. AFY BCBS of IL | Kreyl Ayisyen | Asthma. You may request to have a customer service representative call you at a scheduled time during normal business hours for plan help. When completing the CMS-1500 form, note the following: HIPAA's Administration Simplification provision requires a standard unique identifier for each covered healthcare provider (those that transmit healthcare information in an electronic form in connection with HIPAA-standard claim transactions). information. CVB BCBS of Florida 0000006371 00000 n ), Number assigned to the claim when received by plan. claims status, . AEF BCBS of IL To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. For most plans, we'll deny claims received more than 12 months after the date of service with no member responsibility. PO Box 3876. BCBS Provider Phone Number. . You can get the standardized coverage from this health insurance plan all through the nation. Please provide a detailed description of the service being provided and the code to a member of our Customer Care Team at 1-866-738-3924 and they will provide you with an accurate benefit quote. Tagalog | | Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. Our Customer Care lines will re-open at 6 AM PT the following business day. Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association. DJE BCBS of Alabama ADG Anthem BCBS of Ohio AHI BCBS of Rhode Island complies with applicable Federal and Washington state civil rights laws, Determine the county where the service was performed* (see exceptions below). Provider who rendered the service. CYS BCBS of IL Care Management Programs. Need help with a claim? . If you submit your claims electronically, you may receive electronic remittance for the following: Remittance is available online-just let us know. The claim will be reprocessed and reflected on the payment voucher. That way, we can verify your account and start helping you as quickly as possible. Final Instructions about BCBS Prefix Lookup. We regularly update (at least quarterly) our claims editors to keep pace with changes in medical technology, as well as CPT codes, HCPCS codes, and ICD-10-CM/PCS Diagnosis and Procedure code changes, standards, and complexities. ABT Carefirst BCBS Maryland From there, you will be directed to a new site; at this site, enter in your login information. Mail the overpayment amount to our finance department (address on check) along with a completed Refund Request form, or. If you are outside the U.S. and need to find a local provider, make an appointment or be hospitalized, call Blue Cross Blue Shield Global Core at 1-800-810-2583 or call collect at 1-804-673-1177, 24 hours a day, 7 days a week. Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Regence BlueCross BlueShield of Utah. AHE Empire BCBS This alpha prefix of BCBS plays the major role behind the proper way to claim the health insurance plan without delay and difficulty. Phone: 1-800-628-3481. Find the correct address listed under the type of service received (see explanation). Regence Blue Shield of Idaho - FEPPO Box 30270Salt Lake City, UT 84131-0207. AGG Anthem BCBS of Ohio All Rights Reserved to AMA. | CUW Anthem Blue Cross of California ADJ Anthem BCBS of Missouri Be on . Generally, if the court decrees financial responsibility for the child's healthcare to one parent, that parent's health plan always pays first. AFL Anthem Blue Cross of California If member returns the call and the information is obtained, claims will be processed. Where can I find an Explanation of Payment (EOP)? ** The empty suitcase logo QMG SG OFF Exchange. If we cannot resolve the matter through non-binding mediation, either one of us may institute an action in any Superior Court of competent jurisdiction. Deutsch | The 2015 member identification prefixes for individual Medicare Advantage plans are listed below. CUQ Blue Shield of California Regence BlueShield - FEP PO Box 857 Lewiston, ID 83501. Federal Employee Program Overseas Claims P.O. Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 <<1CC62891B116FE488EB50D904D0BD9AE>]/Prev 176800/XRefStm 1570>> Do not add or omit any characters from the member ID numbers. Tel: 877-668-4651. accrue interest on the 31st day from receipt of the information. Our electronic claims process electronically separates and routes only valid claims for processing. AHW BCBS of MA Illinois. These charges are included in the main anesthesia service. Use search function and put your comment any alpha prefix not found here. In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. Claims. 0000004941 00000 n Get immediate member information by phone or fax . Click on the View Explanation of Payment link. 0000001762 00000 n Use find (Ctrl + F) and enter the prefix to find the BCBS state. Lack of credentialing can be grounds for termination from Premeras network. To ensure accurate claim processing, it is critical to capture all ID card data. It is critical for confirming a patients membership and coverage. If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. AGC MO BCBS MO, POB 419169 , Kansas City , MO , 64141-6169 888-989-8842, AHP Empire Empire BC, POB 5020 , Middletown , NY , 10940 800-772-2875, AHU PPO MD BC MD, 10455 Mill Run Circle , Owings Mills , MD , 21117 877-228-7268, AHW PA BCBS NE PA, 70 N Main St , Wilkes-Barre , PA , 18711 717-829-8500, AIU PA Independence BC, 1901 Market St , Philadelphia , PA , 19103 215-564-2100, AKM MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237 AFS Blue Shield of California If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. News. endstream endobj 597 0 obj <>/Filter/FlateDecode/Index[30 523]/Length 41/Size 553/Type/XRef/W[1 1 1]>>stream Mailing address: Blue Cross of Idaho. 0000008643 00000 n AAP BCBS of Tennessee from receipt of the information. ABZ Carefirst BCBS Maryland FAQs & Resources What type of EDI transactions does RGA accept? Access eContracting to view and sign agreement documents. We will send the member an IQ if the claim(s) is potentially accident-related. You can also call using Skype. Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. . They are identified by Guest Member on their health plan ID card. Payments are issued under a separate voucher and mailed to the address on the original claim. Uniform Medical Plan (UMP) offers you five different health plans through Washington state's Public Employees Benefits Board (PEBB). A subrogation provision is included in both member and physician/provider contracts. They can take note of bcbs alpha prefix online in detail and gain knowledge of how to choose the right alpha prefix. Learn how to contact your local Blue Cross and Blue Shield company, as well as other key areas. CZB Wellmark BCBS Iowa/South Dakota CZK Anthem BCBS of Virginia H\@F. LAB. . CVX BCBS of IL We can process the claim after we receive that information. Regence BCBS Oregon: YVK: Not Assigned Prefix: YVL: Regence BCBS Oregon: YVM: Regence BCBS Oregon: YVO: Regence Blue Cross Blue Shield Oregon: YVP: . AGY BCBS of South Carolina Claims filing information and provider service phone numbers are available in the December, January and February Provider Bulletins. Company Description: Regence BlueCross BlueShield of Oregon provides health insurance products and other managed care services to some 750,000 members in Oregon and Washington's Clark County. For more information, view our privacy policy. 0000000016 00000 n DJD BCBS of Nebraska AGU Carefirst BCBS Maryland 0000008298 00000 n Phoenix, AZ 85072, Phone:800-562-1011 If it is, call the BlueCard Eligibility line 800-676-BLUE (2583) to verify the ID number. AAS Anthem Blue Cross of California Regence BlueShield in accordance with the terms of your Provider contract with Regence. Get help when you need it. Find Contact Information. 1-866-977-7378. 0000087176 00000 n Regence Provider Appeal Form. DJG Anthem BCBS of Ohio Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. 0000055776 00000 n Provider: please send us the radiology reports for this claim. Complete the enrollment form on the following page to receive 835 ERA files from Regence payers . DJS Blue Cross of Idaho (Boise) This review is necessary to determine whether the claim(s) should be covered by a first-party carrier (e.g., PIP, Med Pay or similar coverage - homeowners or a commercial medical premise policy). If all pertinent information is obtained, the claim(s) will then be processed according to the member's contract benefits. We send the member a questionnaire requesting information to determine if benefits are available. The member's benefit program contains special provisions for benefits when an injury or condition is: An onset date should be recorded on all accident-related claims. Only a member can request a Level I or Level II Appeal for a non-billing issue, unless the member has completed a release to allow the provider to act as their Representative. If you have questions about COB, contact Customer Service by calling the phone number on the back of the member's ID card. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. Lastly mail the completed claim form to the address provided. This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. Click on the Submit a Preauthorization Request link. For more information, please visit regence.com, To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. We notify you in writing if the Level II appeal is not timely and your appeal rights will be exhausted. The plan mailing addresses are available on our website under Contact Us. 1/2022) v1 INSTRUCTIONS FOR FILING A CLAIMIMPORTANT: Appeals rights will be exhausted if not received within the required timeframe. Money was posted to your account during the payment cycle. ABI BCBS Minnesota ABY Carefirst BCBS Maryland AHK Anthem Blue Cross of California We may send a questionnaire to the member regarding possible duplicate coverage. 1fcZi=s6Z@n7;W^ugC:CGLi@0^pQY4#o0 y>_ Availity is solely responsible for its products and services. The earlier you submit claims, the earlier we process them. DKB Highmark BCBS CYW Anthem BCBS of Ohio By continuing to use this website, you consent to these cookies. We can't process this claim because we haven't received the necessary information we requested from your provider. If submitting a corrected claim electronically, remember to: For additional instructions on electronic corrected, replacement or voided claims, visit the online section Electronic Transactions and Claim Payer ID, for additional AAT Anthem Blue Cross of California You may like to substitute any prefix of BCBS with an existing BCBS. AFP Anthem BCBS of Ohio AFM BCBS Minnesota You have to avoid this idea when you have geared up for successfully using the health insurance plan. Claims The Prefix tool determines where you should submit a medical claim, either Blue Cross of Idaho or Regence Blue Shield of Idaho, based on an prefix. The SORA is generated when one of the following occurs during a payment cycle: Physicians and providers have the right to appeal certain actions of ours. Additional Contact Information Pharmacy Program. Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. Level II appeals must be submitted in writing within 30 calendar days of the Level I appeal decision and can only pertain to a billing issue. For Example: XYZ123456789. %PDF-1.4 % If you are aware about the bcbs alpha prefix of your health insurance, then you can get the desired support on time for claiming the insurance. We can't process this claim because we haven't received your response to our request for information. 0000015111 00000 n CZU Anthem Blue Cross of California PO Box 33932 Seattle, WA 98133-0932 Phone: 800-562-1011 6:00 AM - 5:00 PM AST Fax: 877-239-3390 (Claims and Customer Service) Fax: 877-202-3149 (Member Appeals only) Fax: 866-948-8823 (FEP Care Management - prior auth/pre-service requests) Email Members: Log in or register - MyBlue Customer eService Retail pharmacy services Claims
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