Email: Medicare/Medicaid: PRmedicaremedicaid@bcidaho.com. See our FAQs for more claim information and contacts. Polski | We are now processing credentialing applications submitted on or before March 14, 2023. CZP Anthem BCBS of Ohio Contact us for health care providers Contact us for healthcare providers. Modifiers. A member is primary on the plan in which he/she is the subscriber versus the plan in which he/she is a dependent. 3. Review our pricing disputes and appeals information to ensure you are following the correct process. Learn more about which practitioners need to be credentialed by viewing our credentialing matrix, located in our credentialing manual, available by request from Credentialing.Updates@premera.com. . ** Make copies of the front and back of the members ID card and pass this key information on to your billing staff. ), Charges billed by physician/provider at a line item level, Amount allowed for service at a line item level, Adjudication explanation code(s) at a line item level and claim level (if applicable), Printed at the end of each claim, the line items are summed and an asterisk indicates the claim total line, Less Paid to Codes Listed as S or C, The sum of the claim total Payable Amounts which have a PD TO code of S or C, The sum of any amount withheld and applied to a prior refund or recovery. AAY Wellmark BCBS Iowa/South Dakota Special Message: Coming soon, you will be able to dispute (appeal) a claim on Availity from the claim status result page. AEG Anthem BCBS of Ohio Box 7408. Members: Log in/register at MyBlue Customer eService, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 31105Salt Lake City, UT 84131, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 1269Portland, OR 97207, Find you will need to contact Regence to update your account to ensure your claim processes correctly and timely. You can verify your address by calling PEBB Customer Service at 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. Use search function and put your comment any alpha prefix not found here. 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. Congestive Heart Failure. 0000004829 00000 n 0000015026 00000 n Regence Blue Cross Blue Shield of Oregon - Yelp A comprehensive list is posted in the Library under Reference Info. Illinois. ABY Carefirst BCBS Maryland 398-0520-PN-NY. To ensure that OCR reads your paper claims accurately: Submitting a corrected claim may be necessary when the original claim was submitted with incomplete information (e.g., procedure code, date of service, diagnosis code). Email: Prproviderrelations@bcidaho.com. Where can I find an Explanation of Payment (EOP)? Open 24 hours a day, 7 days a week. Get immediate member information by phone or fax . Join us! The IQ is available in the Provider Library under Forms. We are unable to quote a benefit by a diagnosis or procedurecode. Additional Contact Information Pharmacy Program. What is an alpha prefix? The three-character alpha prefix at the beginning of the members identification number is the key element used to identify and correctly route claims. Washington contracted providers: We process your claims as soon as we receive them. Provider: send us the NDC #, quantity and date span for this claim. How do I identify BlueCard Managed Care/POS members? By continuing to use this website, you consent to these cookies. Blue Cross and Blue Shield of Illinois P.O. If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Final Instructions about BCBS Prefix Lookup. All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. ABA BCBS of IL BCBS Prefix List ZAA to ZZZ - Alpha Lookup by State 2022 AGY BCBS of South Carolina DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. As a nonprofit independent licensee of the Blue Cross and Blue Shield Association, Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. Stay up to date on what's happening from Bonners Ferry to Boise. . 1-800-423-1973. | Lewiston, ID 83501 . Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. DJS Blue Cross of Idaho (Boise) Employees:Contact your payroll or benefits office. 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. Empire BlueCross moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. AAS Anthem Blue Cross of California 0000014071 00000 n Use only red CMS-1500 forms (no photocopied forms). BCBS Prefix List LAA to LZZ - Alpha Lookup by State 2022 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. We forwarded this claim to the member's home plan for processing. All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. 0000001762 00000 n Verify benefits or eligibility for BlueCard members. We can process the claim after we receive that information. P | (BlueCard will request refunds regardless of the dollar amount.) Modifications we make to your contract or to our policy or procedures are not subject to the appeal process unless we made it in violation of your contract or the law. | Your member ID card is your key to using your medical plan benefits. Atlanta, GA 30348-5557. Prefix State/Area Plan Type Plan Name Provider and member service CMS contract, VOF NY MA HMO MediBlue HMO 1-800-499-9554 H3370 CWB BCBS of Georgia Provider: please send us your operative notes for this claim. As a KingCare member, your care is covered at a higher level inside the network, but the plan also pays a smaller amount toward your bill if you see a doctor outside of the KingCare PPO network. We can process the claim after we receive that information. Provider who rendered the service. Claims. Regence BlueShield Attn: UMP ClaimsP.O. contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 15 percent annual rate on the unpaid or un-denied clean claim. ADQ Independence Blue Cross Examples of ID numbers: As a provider servicing out-of-area members, you may find the following tips helpful: ** Ask the member for the most current ID card at every visit. AEK Independence Blue Cross APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 Asthma. CVC Anthem BCBS of Ohio Regence Blue-Cross Blue-Shield: YAM-Unallocated/Not Assigned: YAN-Unallocated/Not Assigned: YAO-Unallocated/Not Assigned: YAP: Minnesota: Please refer to your electronic billing manual for specific formatting for electronic claims. ** Verify with the member that the ID number on the card is not his/her Social Security Number. any missing required substantiating documentation or particular circumstances requiring special treatment. Provider: please send us your office notes for this claim. CWI Blue Shield of California They require completion and mailing of an Incident Questionnaire for possible accident investigation or a Workers Compensation injury (claims in subrogation). Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. Units shown in box 24G of the CMS-1500 form. hb``d``3g`c`P`eb@ !GCPI+""hr^eA ewJ?hx2-H IM:^7I,y ZPPTP J ! X,/ !q77p0P&{'LYr000 As a beginner to alpha prefix of BCBS at this time, you like to know about the role of the alpha prefix and how to use this alpha prefix properly. note: Exclusions to paying interest may apply based on line of business. Claims may also be delayed during processing if: AlaskaProviders (Non-contracted and ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network Examples: medical doctor, osteopath, optometrist, chiropractor, physical therapist, audiologist, independent laboratory, nurse practitioner, durable DJQ Anthem Blue Cross of California Only appeals received within this period will be accepted for review. No pre-authorization for COVID-19 vaccinations, testing and treatment, No member cost shares for COVID-19 vaccinations, testing and treatment. For more information, please visit regence.com, (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) If you need more information about the NPI mandate, Medicare timelines, and/or the enumeration process, visit the CMS website. Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. CZQ Anthem BCBS of Ohio Find the correct address listed under the type of service received (see explanation). Your office staff can then post this remittance manually or electronically (if your software has electronic posting capability). CYP BCBS of IL The employer group name is usually associated with the alpha prefix of the account specific health insurance type. BlueCard/FEP Lookup | Blue Cross of Idaho - bcidaho.com Attach a completed Corrected Claim - Standard Cover Sheet.. To do so, please submit the proposal in writing to your assigned Provider Network Executive (PNE) or Provider Network Associate (PNA). CZU Anthem Blue Cross of California 0000011774 00000 n Applicable to facility claims only - reflects the APG code, DRG code, or room type that may relate to the reimbursement amounts. All Rights Reserved to AMA. Electronic claims without a TIN are rejected as incomplete. ACH Wellmark BCBS Iowa/South Dakota Policy #s: Regular10017241-0001, Transit10017241-0004, Sheriff10017241-0016, Chinook Building Deutsch | PO Box 52057 national customer service numbers at fepblue.org, Espaol | Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. Claim edits in place will identify those services previously billed and bundle ALL services on to a single The plan doesn't cover cosmetic services. AEV Keystone Health Plan East (IBC) Many offices assign their own account numbers to patients. 0000008433 00000 n UMP Customer ServicePhone: 1 (888) 849-3681 TRS: 711 Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)Chat Live: Sign in to your Regence account Monday through Friday 7 a.m. to 5 p.m. (Pacific) to access chat live. Completion of the credentialing process takes 30-60 days. AFS Blue Shield of California Claims submitted that indicate possible Workers' Compensation illness or injuries are investigated. Contact Us - Uprise Health P.O. BCBS Provider Phone Number. It is only after we determine a members eligibility or coverage that payment policies and edits are applied. AGE Independence Blue Cross . Once we accept your level II appeal, we will respond within 15 days in writing or a revised Explanation of Payment. Paper Claim Form . Plan to submit test claims. Provider Contact Center. Completion of the credentialing process takes 30-60 days. Provider Contacts | Provider | Premera Blue Cross We can't process this claim until the incident questionnaire we sent the member is fully completed, signed and returned. ACS BCBS of IL When Calypso identifies an overpayment, they mail an Overpayment Notification letter with a request for the overpaid amount. 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 People who include both alpha prefix as well as alpha numeric characters precede the alpha prefix in every claim and correspondence submitted to BCBS can get the desired assistance almost immediately. CZM Highmark BCBS This service is considered a standard exclusion. Payment of this claim depended on our review of information from the provider. Box 1106Lewiston, ID 83501-1106Fax: 1 (877) 357-3418 If you have questions about submitting a claim for services outside the U.S., call UMP Customer Service. Deutsch | 24/7 anonymous hotline: 1 (800) 323-1693 What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Availity. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. Federal Employee Program Overseas Claims P.O. CWE BCBS of Michigan 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. Practitioners who arent credentialed may have their claims returned until they submit a complete credentialing application. Medical claims. Email: Contact Regence. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. Our process meets or exceeds the requirements set by the Office of the Insurance Commissioner. Who do I contact for EDI questions? If you are a clinic or hospital-based physician or other qualified healthcare provider, use a CMS-1500 (02-12) form for claims for professional services and supplies related to: This includes claims for outpatient services and services performed by a hospital-based physician or other qualified healthcare provider. EMPIRE BCBS Decides the pre certification requirements based on the prefix id. You can recognize Managed Care/POS members who are enrolled in out-of-area networks through the member identification card as you do for all other BlueCard members. DJR Anthem BCBS of Ohio CUW Anthem Blue Cross of California Is there any way that I can download the contact# with prefix. Please provide a detailed description of the service for preauthorization to a member of our Customer Care Team at 1-866-738-3924 and they will let you know if the service requires preauthorization. Most BCBS-branded ID cards display a three-character alpha prefix in the first three positions of the members ID number. We also apply the following Prompt Pay standards set by the Oregon Insurance Division to our claims adjudication process in order to: A clean claim is one that has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payments from being made on the claim. Seattle, WA 98111-9202, Back to Medical Reference Manuals overview, Espaol | Continue to submit paper claims until you are told to stop. BCBS Prefix List 2021 - Alpha. Centers of Excellence Program administered by Premera Phone: 1 (855) 784-4563 TRS: 711 Business hours: Monday through Friday 7 a.m. to 5 p.m. (Pacific), Puget Sound High Value NetworkPhone: 1 (855) 776-9503TRS: 711Business hours: Monday through Friday 7 a.m. to 7 p.m. (Pacific), UW Medicine Accountable Care NetworkPhone: 1 (888) 402-4237TRS: 711Business hours: Monday through Friday 5 a.m. to 8 p.m. (Pacific).