Eastern WA and Alaska providers submit to Premera. The IQ is available in the Provider Library under Forms. Alaska contracted and non-contracted Completion of the credentialing process takes 30-60 days. 0000008944 00000 n CWJ BCBS of Alabama AGY BCBS of South Carolina 0000000016 00000 n Monday-Friday, 8-5 Pacific (800) 552-0635 www.CarpentersBenefits.org. EMPIRE BCBS Decides the pre certification requirements based on the prefix id. to 6:00 PM PT or log in to your RGA account and submit an electronic request. . 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. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. We can't process this claim until the incident questionnaire we sent the member is fully completed, signed and returned. You can submit claims daily, weekly, or monthly. Regence BlueShield - FEPPO Box 31207Salt Lake City, UT 84131, (Attended sleep study at outpatient part of a hospital, home hospice, organ/tissue transplants, clinical trials. AES BCBS of Alabama They include a request of medical records for review. If you already have a computer system, notify your software vendor of your desire to convert to electronic claims. This includes New York, New York 10008-3876. That way, we can verify your account and start helping you as quickly as possible. Physicians and providers may submit a proposal to modify a payment policy. When applicable, we will suspend payment until we determine which carrier is primary and which is secondary. You can learn more about credentialing by visiting the provider section of our website. If you require a written refund request before mailing the overpayment, contact Calypso directly at 800-364-2991. National Correct Coding Initiative (NCCI) editing is followed when applicable. Franais | AIE BCBS of Michigan Thank you for choosing Regence as your health plan administrator. Prefix Tool. They require completion and mailing of an Incident Questionnaire for possible accident investigation or a Workers Compensation injury (claims in subrogation). ABZ Carefirst BCBS Maryland 0000008433 00000 n Prescriptions. Payment of this claim depended on our review of information from the provider. By continuing to use this website, you consent to these cookies. They are identified by Guest Member on their health plan ID card. Once the submission is complete and if the issue is billing related, we review the request and issue a decision within 30 days, along with your right to submit a Level II Appeal if you are not satisfied with the outcome. ADJ Anthem BCBS of Missouri AEV Keystone Health Plan East (IBC) You can make a complaint verbally to Customer Service or in writing to Customer Service Correspondence. Here are common reasons why claims suspend or reject: Contact Customer Service with questions regarding claims processing or send a copy of the voucher highlighting the claim in question and the inquiry reason. When submitting claims, transfer the members identification (ID) number exactly as printed on the ID card. ADF Healthnow of NY Buffalo What type of EDI transactions does RGA accept? Completion of the credentialing process takes 30-60 days. Related . ACL Anthem Blue Cross of California (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). Unclean claims will begin to Call 1 (855) 522-8894. YDO Retail OFF Exchange DKB Highmark BCBS 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. We will response ASAP. AAZ Anthem Blue Cross of California We notify you in writing if the request for mediation is not timely. Karen Lyons, APR Sr. Director, Public Relations 612.777.5742 klyons@primetherapeutics.com. Blue Cross and Blue Shield of Illinois P.O. | To contact us without setting your ZIP code, call: Prescription questions?Call Customer Service and choose the Pharmacy option. 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. We can't process this claim because we haven't received your response to our request for information. Regence BlueShield in accordance with the terms of your Provider contract with Regence. Box 105557. ACQ BCBS of Georgia 0000001240 00000 n 0000055309 00000 n These claim editors evaluate billing information and coding accuracy on submitted claims and assists in achieving consistent, accurate, and timely processing of physician and provider payments. Resource-based relative value scale (RBRVS) Claims adjudication system Claims Editors Payment Policies Payment policies Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. LAB. All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. 0000125980 00000 n | Bill all original lines-not including all of the original lines will cause the claim to be rejected. If Workers' Compensation denies payment of such claims, Premera will pay according to the subscriber's contract benefits after receiving a copy of a valid denial. ADA Anthem Blue Cross of California Your member ID card is your key to using your medical plan benefits. AHI BCBS of Rhode Island Before discussing member claim information, the Customer Service representative must verify the identity of the caller. Your Claims & Eligibility. AAQ Anthem BCBS of Ohio This prefix is the part of the distinctive identification number. By continuing to use this website, you consent to these cookies. AHK Anthem Blue Cross of California Final Instructions about BCBS Prefix Lookup. AHO BCBS of Tennessee Complaints received beyond the 365-day timeframe will not be reviewed and the appeals rights pertaining to the issue will be exhausted. Coronary Artery Disease. Regence BlueShield Attn: UMP ClaimsP.O. CZC Anthem BCBS of Ohio Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. 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. CWF BCBS of Georgia Primary submission: Show all insurance information on the claim, and then submit the claim to the primary plan first. Verify eligibility via Highmarks NaviNet. CZP Anthem BCBS of Ohio CZE Anthem Blue Cross of California CWQ Anthem BCBS of Ohio ABU BCBS Minnesota Once we accept your level II appeal, we will respond within 15 days in writing or a revised Explanation of Payment. 24/7 Nurse Line: 800-267-6729. 0000014956 00000 n BCBS Prefix List 2021 - Alpha. If member does not return the call, claims will be denied until information is received. PO Box 3876. 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. P.O. P | CUZ Anthem BCBS of Ohio Regence BlueCross BlueShield of Utah. Fraud or abuse You can remain anonymous. Kreyl Ayisyen | ** The empty suitcase logo AGF Anthem BCBS of Ohio Premera Blue Cross & The Regence Group Common Alpha Plan Prefixes Last updated: 09/01/2016 Premera Blue Cross & Premera Blue Cross/NASCO Prefixes Western WA providers submit claims to Regence Blue Shield. DJN BCBS Minnesota | If you are unable to submit claims electronically, you can submit paper claims on CMS-1500 or UB-04 forms. Box 805107 Chicago, IL 60680-4112 Iowa . AEZ Wellmark BCBS Iowa/South Dakota 0000018816 00000 n This alpha prefix of BCBS plays the major role behind the proper way to claim the health insurance plan without delay and difficulty. There is a balance due to us at the end of the payment cycle. To contact Corporate, please call 1-425-462-1000 Monday - Friday 8:00 AM to 5:00 PM PT. DJW Wellmark BCBS Iowa/South Dakota User the HIPAA 837 standard claims transaction including the following information: Frequency code of 7 in look 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. CVZ Horizon BCBS of New Jersey 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. Heres everything you need to know about it. CZR Wellmark BCBS Iowa/South Dakota Click on the View Explanation of Payment link. . Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. providers: We process your claim as soon as we receive them. https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. 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. See the following pages for an explanation of the EOP fields and a description of codes and messages. ), 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. Kreyl Ayisyen | (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) Regence BlueShield - FEP PO Box 1388 Lewiston, ID 83501 Customer Service. DJT BCBS Minnesota Hours: 8 a.m. 4:30 p.m. weekdays, Find certified small business contractors and suppliers. DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. Postal Prescription ServicesOnline: Your PPS accountPhone: 1 (800) 552-6694TRS: 711Fax (for providers only): 1 (800) 723-9023Business hours: Monday through Friday 6 a.m. to 6 p.m. and Saturday 9 a.m. to 2 p.m. (Pacific), Ardon HealthPhone: 1 (855) 425-4085TRS: 711Fax (for providers only): 1 (855) 425-4096Business hours: Monday through Friday 8 a.m. to 7 p.m. and Saturday 8 a.m. to 12 p.m. (Pacific), Online: Medicare or MyMedicarePhone: 1 (800) MEDICARE (1-800-633-4227)TTY: 1 (877) 486-2048. 0000006371 00000 n You can also use the Office of Financial Management MyPortal to update your address. The earlier you submit claims, the earlier we process them. All Rights Reserved to AMA. 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. Deutsch | ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. We'll notify you in writing or by telephone when you have successfully completed the test phase. If you get the plan specific alpha prefix, then the first two characters in this prefix are used to identify your plan. AAT Anthem Blue Cross of California endstream endobj 597 0 obj <>/Filter/FlateDecode/Index[30 523]/Length 41/Size 553/Type/XRef/W[1 1 1]>>stream Regence BlueShield of Idaho offers health and dental coverage to 142,000 members throughout the state. You can get the standardized coverage from this health insurance plan all through the nation. Enter the three digit alphanumeric prefix located on the member's ID card, and the tool provides the correct insurance carrier for you. Precertification remains the responsibility of the provider for all Empire HMO network members. AHJ Independence Blue Cross If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. Need information from the member's other insurance carrier to process claim. 0000015111 00000 n Our medical staff reviewed this claim and determined that this service isn't covered by the plan. A comprehensive list is posted in the Library under Reference Info. ** Members who are part of the FEP will have the letter R in front of their member ID number. . Once we have received a payment ledger from the first-party carrier(s) showing where they paid out their limits (with dates of services, provider names, total charges, total paid, etc. Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). CZF BCBS of Rhode Island Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. Mailing address: Blue Cross of Idaho. AID Anthem BCBS of Ohio AAB BCBS of Michigan DAU Anthem BCBS of Missouri This member wasn't eligible for services on the date of service. Congestive Heart Failure. In Washington, Premera Blue Cross and Regence BlueShield share responsibility for claims processing, customer service, and prior authorization requests based on where the patient receives the service and what kind of service was received. DBT BCBS of Michigan CUW Anthem Blue Cross of California If member returns the call and the information is obtained, claims will be processed. Be on . Regence Blue-Cross Blue-Shield: HCT BCBS Prefix: Pennsylvania: Highmark Blue-Cross Blue-Shield of Pennsylvania: HCU: Tennessee: Blue-Cross Blue-Shield of Tennessee: HCV: Regence DJF Anthem BCBS of Virginia ABR Carefirst BCBS Maryland The charges for this service have been combined into the primary procedure based on the provider's contract. This is a claim adjustment of a previously processed claim. | YUV SG ON Exchange If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. A subsidiary of Cambia Health Solutions (formerly Regence Group) and one of Oregon's largest health plan provider, the company offers both group and individual health policies, including PPO plans and . Contact us for health care providers Contact us for healthcare providers. Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. ** Do not change the sequence of the characters following the alpha prefix. AAX Anthem Blue Cross of California To speed claims processing, we use document imaging and optical character recognition (OCR) equipment to read your claims. You can reach Customer Service by calling 877-342-5258, option 2, or by calling the Customer Service phone number on the back of the member's ID card. Type forms in black ink (handwritten forms cannot be read by OCR equipment). 0000087176 00000 n View remittance advices. 0000128769 00000 n 1 (877) 878-2273 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). You have 365 calendar days to submit a complaint following the action that prompted the complaint. Heres everything you need to know about it. CVV Anthem Blue Cross of California If you have questions about COB, contact Customer Service by calling the phone number on the back of the member's ID card. Pay or deny 95 percent of a provider's monthly clean claims within 30 days of receipt; and. Attach a completed Corrected Claim - Standard Cover Sheet.. AFO Arkanasa Here are examples: A Level I Appeal must be submitted with complete supporting documentation that includes all of the following: Incomplete appeal submissions are returned to the sender with a letter requesting information for review. 0000013357 00000 n Empire BlueCross moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015. Many residents in our time do not aware about how they can decide on the alpha prefix and reap more than a few benefits from the best suitable health insurance plan. CVS Caremark. Do not add or omit any characters from the member ID numbers. medical equipment supplier, ambulance services, applied behavior analysis services (ABA) or clinical social worker. AFB BCBS of South Carolina We do not request refunds for overpayments less than $25, but you may submit these voluntarily. | Blue Cross and Blue Shield of Illinois P.O. All of our contracts exclude coverage for care covered under the Workers' Compensation Act. DKA Wellmark BCBS Iowa/South Dakota A members ID number includes the alpha prefix in the first three positions and all subsequent characters between 6 and 14 numbers or letters up to 17 characters total. The provider appeals process does not apply to FEP, BlueCard Home Claims, Medicare Supplement plans, or Medicare Advantage plans. The mediator's fees are shared equally between the parties. ** PPO in a suitcase logo, for eligible PPO members For more information about RBRVS methodology visit the CMS website. RBRVS is a method of reimbursement that determines allowable fee amounts based on established unit values as set norms for various medical and surgical procedures, and further based on weights assigned to each procedure code. Western WA providers submit claims to Regence Blue Shield. 0000018886 00000 n All Excellus plans use this mailing address: Excellus BCBS Attn: Claims P.O. We haven't received the information. If the member does not return the IQ within the specified timeframe, we'll deny all related claim(s). hb``d``3g`c`P`eb@ !GCPI+""hr^eA ewJ?hx2-H IM:^7I,y ZPPTP J ! X,/ !q77p0P&{'LYr000 P.O. ACN BCBS of IL CWB BCBS of Georgia Prefix Plan Name, AAA BCBS of Alabama AFC BCBS of IL The main identifier for out-of-area members is the alpha prefix. Its often confused that BCBS have lot of prefixes and where to contact. 4. BCBS Provider Phone Number. ADY BCBS of South Carolina Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. providers: We process your claim as soon as we receive them. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. 1-877-764-8724 Email Us. Most BCBS-branded ID cards display a three-character alpha prefix in the first three positions of the members ID number. Asthma. YDZ SG OFF Exchange 1 (888) 675-6570 Prescription questions? An interest check is issued only for months in which the accumulated interest is equal to or greater than the minimum threshold of $25. 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. Providers. AAS Anthem Blue Cross of California Blue Cross Blue Shield Federal Phone Number. Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). 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 Paper Claim Form . ), Covered under the provisions of motor vehicle medical policy, personal injury protection (PIP), medical payments (Medpay), Uninsured (UIM) and/or underinsured (UM) motorist or other similar coverage (e.g., homeowners, commercial medical premises), Checks for eligibility of the member listed on the claim, Compares the services provided on the claim to the benefits in the subscribers contract, Applies industry standard claim edits and applicable payment policy criteria, Applies to professional and facility claims. You may like to substitute any prefix of BCBS with an existing BCBS. Lewiston, ID 83501 . Regence BCBS Oregon: YVK: Not Assigned Prefix: YVL: Regence BCBS Oregon: YVM: Regence BCBS Oregon: YVO: Regence Blue Cross Blue Shield Oregon: YVP: . Email: Contact Regence. ADI Anthem Blue Cross of California If you submit your claims electronically, you may receive electronic remittance for the following: Remittance is available online-just let us know. This claim was paid previously to the provider or applied to the member's deductible. The conversion factor represents the dollar value of each relative value unit (RVU). Uniform Medical Plan (UMP) offers you five different health plans through Washington state's Public Employees Benefits Board (PEBB). Verify benefits or eligibility for BlueCard members. We're here to help (651) 662-5200 1-800-262-0820 . AGT Blue Shield of California 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. A detailed description of the disputed issue, All evidence offered by you in support of your position including medical records, A description of the resolution you are requesting. Please reach out and we would do the investigation and remove the article. Please treat these members the same as domestic Blue Plan members. Contact. Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Use search function and put your comment any alpha prefix not found here. DJD BCBS of Nebraska ** A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total. However, there are some exceptions. Box 3004 Naperville, IL 60566-9747. Please request a current ID card from the member. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). The claim will be reprocessed and reflected on the payment voucher. Boise, ID 83707. This procedure is considered cosmetic. Sign the completed form where indicated at the bottom of this page and submit the completed claim form to: Regence BlueShield Attn: UMP Claims PO Box 1106 Lewiston, ID 83501-1106 or by fax to: 1 (877) 357-3418 Payments will be mailed to the address on file for the subscriber. Use 8 to void a claim billed in error, The initial claim number (in loop 2300, REF01 must contain F8 and REF02 must contain the claim number). Log in to Availity Don't have an Availity account? YDM SG Off Exchange Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. information. That's why Anthem uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. AHX Horizon BCBS of New Jersey When we process a claim, we coordinate benefits if the member has other primary coverage from another carrier, our health plan, service plan, or government third-party payer. 1-800-423-1973. 398-0520-PN-NY. A subrogation provision is included in both member and physician/provider contracts. The three characters preceding the subscriber identification number on BCBS member ID cards. Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 This standard is called the "Birthday Rule.". Where do I determine if a code is covered? Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. To find a health care provider in the KingCare network, go to Find a doctor and sign in to your Regence BlueShield account. 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.

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