Claims. 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. DHA Excellus BCBS Utica CWQ Anthem BCBS of Ohio Applicable to facility claims only - reflects the APG code, DRG code, or room type that may relate to the reimbursement amounts. Subrogation permits the plan to recover payments when the negligence or wrongdoing of another causes a member personal illness or injury. We require that you verify the information about your practice and the networks you participate in at least every 90 days. Portugus | 0000018383 00000 n endstream endobj 597 0 obj <>/Filter/FlateDecode/Index[30 523]/Length 41/Size 553/Type/XRef/W[1 1 1]>>stream CZM Highmark BCBS All of our contracts exclude coverage for care covered under the Workers' Compensation Act. DJW Wellmark BCBS Iowa/South Dakota Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. The Federal Employee Program (FEP) NO LONGER uses the address below, and mail will discontinue to be forwarded to the correct address above. ALR AR BC AR, PO Box 2181 , Little Rock , AR , 72203-2180 888-847-1400, AMU RI BCRI, 444 Westminister St , Providence , RI , 02903-3279 401-831-7300, AMZ KY BC KY, POB 37690 , Louisville , KY , 40233 800-925-0135, AON IL BC IL, POB 1364 , Chicago , IL , 60690 800-972-8088, APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 0000004073 00000 n (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) 0000010231 00000 n 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. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) Your software vendor can help you set up your computer to accommodate Premera's billing requirements. Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. AGY BCBS of South Carolina COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. We recommend that you make copies of everything that is submitted for your personal records. DAC BCBS of Tennessee Receiving payment Featured In: May 2020 Empire Provider News. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. What type of EDI transactions does RGA accept? The protection of your privacy will be governed by the privacy policy of that site. CZV BCBS of Alabama Uprise Health General Access . 0000056226 00000 n (for both professional and facility claims) using claim frequency code 7. We notify you in writing if the request for mediation is not timely. ABG BCBS of Georgia ABI BCBS Minnesota ** Make copies of the front and back of the members ID card and pass this key information on to your billing staff. Join us! We send the member a questionnaire requesting information to determine if benefits are available. We use cookies on this website to give you the best experience and measure website usage. 0000008298 00000 n If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. | QAB. Always use the alpha prefix on the members current ID card. If there is no alpha prefix, do not create one or use an alpha prefix from another members ID card, even one from the same BCBS Plan. For more specific contact information, choose from the following: Individuals and families Medicare Employers Producers Providers Fraud or abuse You can remain anonymous. Kreyl Ayisyen | ** PPO in a suitcase logo, for eligible PPO members View your credentialing status in Payer Spaces on Availity Essentials. 0000015111 00000 n Italiano | After these steps are completed, you can choose one of the following options to resolve the overpayment: Calypso will apply the refund to the claim as soon as they receive the refund. Pay clean claims within 30 days of receipt; and, Pay unclean claims within 15 days after receipt of information, Pay unclean claims within 30 days after receipt of information. Call 1 (855) 522-8894. When we are the primary carrier, we calculate and pay benefits routinely. medical equipment supplier, ambulance services, applied behavior analysis services (ABA) or clinical social worker. ** Remember: Member ID numbers must be reported exactly as shown on the ID card and must not be changed or altered. When a Medicare patient received services that Medicare specifically requires to be submitted on separate claim forms, this one claim requirement will not apply. Regence BlueShield Attn: UMP ClaimsP.O. 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. AGX Anthem BCBS of Virginia Eligibility, enrollment, and address/name changes. The employer group name is usually associated with the alpha prefix of the account specific health insurance type. Claims submission Learn more about billing and how to submit claims to use for payment. In general, there are two categories of alpha prefixes namely account specific and plan specific alpha prefixes. Verify benefits or eligibility for BlueCard members. Management - prior auth/pre-service requests), Email: Members: Log in/register at MyBlue Customer eService, Regence BlueShield - FEPPO Box 21709Seattle, WA 98111. They can take note of bcbs alpha prefix online in detail and gain knowledge of how to choose the right alpha prefix. The Level I Appeal must be submitted within 365-days following the action that prompted the dispute. In these cases, please don't return the check to us. DJY Anthem BCBS of Ohio Asthma. ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. This member wasn't eligible for services on the date of service. LAA. Atlanta, GA 30348-5557. DCY BCBS of Florida Mail a completed Overpayment Notification form (found in our online library under Forms) and mark the box requesting a voucher deduction to recover the overpayment on future claim payments. . AAZ Anthem Blue Cross of California Eastern WA and Alaska providers submit to Premera. 553 0 obj <> endobj We forwarded this claim to the member's home plan for processing. 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). Box 105557. (BlueCard will request refunds regardless of the dollar amount.) ACR Anthem Blue Cross of California Call Customer Service and choose the Pharmacy option. Prescriptions. These charges are included in the main anesthesia service. YDW Retail OFF Exchange 7:00 AM - 6:00 PM PSTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care Supplier Registration ADC BCBS of IL . An EDI representative will review the test claims with you or your vendor. DKC BCBS of Texas AFB BCBS of South Carolina If you bill your claims using the ANSI 837 electronic format, then you must include the Coordination of Benefits (COB) information from the primary coverage payer in your claim. The earlier you submit claims, the earlier we process them. 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. YDZ SG OFF Exchange AAP BCBS of Tennessee The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. 0000008643 00000 n 4. We haven't received the information. ACV BCBS of Georgia Coronary Artery Disease. 598 0 obj <>stream Note: Some members will remain in Blue Cross of Northeastern Pennsylvania health plans until their coverage renews to Highmark health plans later this year. Also its not a sequential order hence its hard to find unless we check with first 3 alpha prefix. This claim is a duplicate of a previously submitted claim for this member. We will notify you once your application has been approved or if additional information is needed. 3. P.O. You could download the full BCBS prefixes list is here. All services rendered by the same provider for the same patient for the same date of service must be submitted on one claim form. To cancel or waive your coverage, visit the PEBB Program website using these links: Uniform Medical Plan (UMP) is a self-insured Preferred Provider Organization (PPO) medical plan offered through the Washington State Health Care Authority. Congestive Heart Failure. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Health . A required waiting period must pass before we can provide benefits for this service. Before discussing member claim information, the Customer Service representative must verify the identity of the caller. ALN PA BC PA, Highmark, POB 1210 , Pittsburgh , PA , 15230 800-433-9906 DJN BCBS Minnesota However, fax submission is allowed at the ollowing fax numbers: 866-365-5504 or 303-764- 7123 for BCBS OF CA AND BCBS OF CO. View remittance advices. When you go to this page, you should see a dialog box that asks for your ZIP code. . ADF Healthnow of NY Buffalo If member does not return the call, claims will be denied until information is received. DJJ Horizon BCBS of New Jersey To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. Your member ID card is your key to using your medical plan benefits. Mail this claim to: Regence BlueCross BlueShield of Utah PO Box 1106 Lewiston, Idaho 83501 Or Fax claim to: (888) 606-6582 FORM PD020-UT Page 2 of 3 (Eff. AHI BCBS of Rhode Island Get help when you need it. 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). ABY Carefirst BCBS Maryland ** When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the members card. 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. . You have 365 calendar days to submit a complaint following the action that prompted the complaint. Tel: 877-668-4651. 0000014956 00000 n Were ready. ADT BCBS Minnesota Availity supports the exchange of electronic remittance advice (ERA) files for Regence payers in the ASC X12 835 format. If you are not registered, please click on the Not Registered link to set up your account. Additional Contact Information Pharmacy Program. Italiano | Remember to include the leading three-character prefix and enter it in the appropriate field on the claim form. Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). Refer to your contract for further claims submission information. ACX BCBS of IL or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, 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 are unable to quote a benefit by a code. Please reach out and we would do the investigation and remove the article. While you pay for coverage through UW, the state designs the plans and contracts with Regence BlueShield and Washington State Rx Services to administer the plan. You can also use the Office of Financial Management MyPortal to update your address. 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. 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. AAS Anthem Blue Cross of California Our Customer Care lines will re-open at 6 AM PT the following business day. 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: 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. If we do not receive the EOB and are unable to obtain the primary payment information by phone, the claim will be denied with a request for a copy of the primary EOB before processing can be completed. DJQ Anthem Blue Cross of California | ABU BCBS Minnesota CZQ Anthem BCBS of Ohio If you are unsure how to submit secondary claims electronically, contact your practice management system vendor or contact an EDI representative at 800-435-2715. ACS BCBS of IL However, name changes can be done only through your payroll or benefits office. Continue to submit paper claims until you are told to stop. CVG BCBS of Florida CYV Anthem BCBS of Missouri Heres everything you need to know about it. CYJ Horizon BCBS of New Jersey Costco Mail-Order PharmacyOnline: Sign in to your Costco accountPhone: 1 (800) 607-6861TRS: 711Fax: 1 (800) 633-0334Business hours: Monday through Friday: 5 a.m. to 7 p.m. (Pacific) Saturday: 9:30 a.m. to 2 p.m. (Pacific)Note: UMP members do not need to be Costco members to use their mail-order service. AFG BCBS of Nebraska | AAB BCBS of Michigan Below you will find a list of the 2015 BCNEPA plans with the corresponding Highmark Blue Cross Blue Shield plans for 2016. Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. Disclosure Notice Patient Protection Surprise Billing, 270/271 Eligibility inquiry and response, 278 Referral certification and authorization, 837 Claims and encounters (P, D, and I). Precertification remains the responsibility of the provider for all Empire HMO network members. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. Coding toolkit View our clinical edits and model claims editing. 0000008944 00000 n YDV SG ON Exchange the instructions to determine where to send claims or correspondence. BCBS Company. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. Box 805107 Chicago, IL 60680-4112. When the conversion factor is multiplied by the total RVUs, it will yield the reimbursement rate for the specific service (or code). | To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. AFZ Anthem Blue Cross of California AAY Wellmark BCBS Iowa/South Dakota You have to bear in mind that the alpha prefix has three letters usually followed by the identification of member of BCBS. The dates-of-service (to and from - also referred to as beginning and ending dates) at a, The code/modifier shown in box 24D of the CMS-1500. BCBS Provider Phone Number. Select the area of the map that matches the color of the county where the service was performed. For more information, view our privacy policy. We're ready. Provider: send us the NDC #, quantity and date span for this claim. Plan to submit test claims. Send us other carrier's explanation of benefits. 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. BCBS Provider Phone Number. 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. Contact. They are suspended due to the group or individual's non-payment of premium or dues. AEZ Wellmark BCBS Iowa/South Dakota UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees. We are unable to quote a benefit by a diagnosis or procedurecode. When this notification has occurred, change the indicator on your claims from (. Need help with a claim? 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. It identifies the members Blue Cross Blue Shield company or national account in order to properly route the claim. . 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. Find the correct address listed under the type of service received (see explanation). All Blue Plans replaced Social Security numbers on member ID cards with an alternate, unique identifier. You can learn more about credentialing by visiting the provider section of our website. any missing required substantiating documentation or particular circumstances requiring special treatment. Final Instructions about BCBS Prefix Lookup. For more information, please visit regence.com, If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). If there are no court decrees, the plan of the parent with custody is primary. Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. Michigan. Seattle, WA 98111-9202, Back to Medical Reference Manuals overview, Espaol | Claim Forms; Get to know your member ID card. BJF NCJ YLB YLG YLX BJT RFB YLC YLK YLY EHP SWH YLD YLN YLZ MES YLA YLE YLW, Network Name Old Alpha Prefix New Alpha Prefix, YDQ Retail ON Exchange Once you have signed in, simply click on the Authorizations on the top menu and you will be able to submit your preauthorization request. BCBS Provider Phone Number. ** A local network identifier, (for example, BlueMark) Need help with a claim? AFM BCBS Minnesota Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Pay or deny 95 percent of a provider's monthly clean claims within 30 days of receipt; and. All people who have BCBS health insurance policy have to make copies of their ID front and back and keep such records on hand. Regence health plans operate in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable. Blue Cross and Blue Shield of Illinois P.O. AEV Keystone Health Plan East (IBC) Units shown in box 24G of the CMS-1500 form. Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. Please refer to your electronic billing manual for specific formatting for electronic claims. This standard is called the "Birthday Rule.". Claims & payment Claims and payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. We use an automated processing system to adjudicate claims. 0000014071 00000 n You must request mediation in writing within 30 days after receiving the Level II appeals decision on a billing dispute. We can't process this claim until the questionnaire we recently sent the member is completed and returned to us. YDM SG Off Exchange AEJ Horizon BCBS of New Jersey If you know which division you would like to contact, you can also reach out directly using the following phone numbers and email addresses. Regence Blue-Cross Blue-Shield: ZBU: Illinois: Blue-Cross Blue-Shield of Illinois: ZBV: Wisconsin: Anthem Blue-Cross Blue-Shield of Wisconsin: ZBW: South Dakota/Iowa: 1fcZi=s6Z@n7;W^ugC:CGLi@0^pQY4#o0 y>_ ABR Carefirst BCBS Maryland That way, we can verify your account and start helping you as quickly as possible. AHE Empire BCBS In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. complies with applicable Federal and Washington state civil rights laws, Determine the county where the service was performed* (see exceptions below). Note that some processing systems may have a limitation regarding the number of characters recognized. If the information is not captured correctly, you may experience a delay with the claim processing. 0000008433 00000 n Deutsch | In third-party cases, this provision permits the plan to recover the medical bill costs on behalf of the member.

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