The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications An incorrect or missing three-character prefix may cause possible delays in the processing of your claims. Call 1-800-388-3193 . Added to list, with AIM effective 04/01/2021 22802 Joint, Spine Surgery Post Fusion 7-12 Vert Seg SUR712.036 AIM Guidelines Lumbar Spinal Fusion Retire from BCBS PA effective 1/1/22; continue to request PA through AIM if applicable; Added to list, with AIM effective 04/01/2021 22804 Joint, Spine Surgery Post Fusion 13/> Vert Seg SUR712.036 AIM . The three-character prefix at the beginning of the members identification number is the key element used to identify and correctly route out-of-state claims to the appropriate BCBS Plan. BCBS Alpha Prefix List The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. BCBS Railroad refers to Blue Cross Blue Shield health insurance plans that are specifically designed for members who are affiliated with railroad organizations in the United States. 2021 Commercial Prior Authorization Requirements Summary (Updated December 2020) This document provides an overview of services/care categories for which prior authorization may be required for some commercial, non-HMO Blue Cross and Blue Shield of Illinois (BCBSIL) members. ;MTK View Medicare information Radiology utilization for Arkansas Blue Cross FEP It means that BCBS members IDs prefixes will must have alphabets. For Federal Employee Program (FEP) precertification requirements, please see the separate FEP precertification list. 1229 0 obj <> endobj The most important and easy way to identify BCBS member is his BCBS member ID alpha prefix. Prefix Group Address Group Name TPA Name & Address Claims Filing Claims & Benefit Contact Name Phone . The three-character prefix at the beginning of the member's identification number is the key element used to identify and correctly route out-of-state claims to the appropriate BCBS Plan. (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. 365 0 obj <> endobj 15363 0 obj <> endobj BCBS Prefix AAA Home Plan and Phone Number, BCBS Alpha Numeric Prefix from Y2A to Y9Z, BCBS Alpha Numeric Prefix from X2A to X9Z, BCBS Alpha Numeric Prefix from W2A to W9Z, BCBS Alpha Numeric Prefix from V2A to V9Z, Frequently Asked Questions Related to BCBS Prefix. You may see cards with four-character prefixes, e.g., HMSA Blue Cross Blue Shield of Hawaii uses four-character prefixes. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Xceed Billing Solutions motive is to create ease for providers, medical billers, patients and everyone who is involved in revenue cycle process. There are several benefits of using our BCBS Prefix Lookup tool. Address: 11070 Katy Fwy, Houston, TX 77043, 2023 Xceed Billing Solution.com - All Rights Reserved, Blue Cross Blue Shield BCBS Prefix List Lookup. Policy number is a unique number, which is provided to their insured person by respective insurances in order for identification purposes and also for billing the healthcare claims. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). Current prefixes will still be valid once the new alpha-numeric prefixes are issued, unless there is another need to change or remove a prefix . We make it easy for you to offer the healthcare coverage that delivers for your business. ). BCBS prefix lookup directory is a valuable resource for anyone who is looking for right Blue Cross Blue Shield home plan. Box 14114 Lexington, KY 40512 Federal Employee Program (FEP) R prefix DC/Metropolitan Area 2024884900 MD 8008545256 DC/Metropolitan Area Mail Administrator P.O . Does BCBS Cover Wegovy for Weight Loss? BCBS Prefix should be included along with ID number, exactly as it appears on the member ID card when filing the claims to insurance company. Secondly, it ensures that you have the most up-to-date information about each and every BCBS prefix home plan because we update the BCBS prefix list on daily basis. Member identification numbers beginning with R belong to Federal Employee Program (FEP) and will not have a three-character prefix when filing. Second Character G assigned to the BCBS Plan as well. BCBS Alpha Numeric Prefix - It's a three letter Alpha numeric prefix followed by id number. So, to accomplish our goal, we have listed down the complete BCBS alpha prefix list so that you can easily identify correct BCBS plan. BCBS Alpha Prefix list is useful for both providers and BCBS enrolled members/patients. This new site may be offered by a vendor or an independent third party. =&m$ z90P&\:?$IRIj"c5l\"aD(@?Yuk>{8lkelu3X*FpT=6Rv;9'*4O-o|ELLG?-Yec,cqh(e96e4^QyD8H}'o(3 plan. Wheelchairs - Mobility Assistive Equipment (Manual & Power) & Scooters - Wheelchair Purchase only -Motorized) Wheelchair: E1050, E1060, E1070, E1083, E1084, E1085 . Lets dig into it! %%EOF %%EOF You can also contact us for specialty medical billing services. Not assigned prefix. Prior Authorization List for Blue Shield Effective April 1, 2023 (This list is updated monthly) blueshieldca.com 601 12th Street | Oakland, CA 94607 Blue Shield of California is an independent member of the Blue Shield Association April 1, 2023 Page 1 of 8 Policy Name/Program Procedure Code (To search, press Ctrl + F) . On the other hand, the BCBS member ID number is a unique identifier assigned to each individual member covered under a BCBS health insurance policy. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). PAGE : Amkor Technology, Inc. Group # 039176 : AmeriBen . We always make sure to keep BCBS prefix list and BCBS provider phone numbers directory up to date. 0 In some case provider or billing company may file the claim to an incorrect address without checking the correct BCBS address. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Xceed Billing Solutions is amedical billing company for outsourcing medical billing services. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. BCBS member ID card will have a suitcase logo at the bottom of card which will also help you to identify patient plan like HMO, PPO, POS etc. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue . The policy number is a unique identifier which may cover multiple members under the same policy, such as a family or a group. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. endstream endobj 15364 0 obj <>>>/EncryptMetadata false/Filter/Standard/Length 128/O(a;uY[7y\\ Y)/P -1036/R 4/StmF/StdCF/StrF/StdCF/U(ZgYX: )/V 4>> endobj 15365 0 obj <>/Metadata 280 0 R/PageLayout/OneColumn/Pages 15351 0 R/StructTreeRoot 2939 0 R/Type/Catalog>> endobj 15366 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 15367 0 obj <>stream Unraveling the Truth, United Healthcare Claims Address, Payer ID, Fax and Phone Number, BCBS Prefix List 2023 Alpha Prefix and Alpha Number Prefix Lookup, BCBS Alpha Numeric Prefix from L2A to L9Z (Updated 2023), BCBS Provider Phone Number for Claims and Eligibility Verification, Benefits and Eligibility Verification Services. One option is Adobe Reader which has a built-in reader. No, the BCBS policy number is not typically the same as the BCBS member ID number. DIGNITY HEALTH YAVAPAI REGIONAL MEDICAL CENTER AND BLUE CROSS BLUE SHIELD OF ARIZONA REACH AGREEMENT, FIESTA BOWL AND BLUE CROSS BLUE SHIELD OF ARIZONA OPEN APPLICATIONS FOR FOURTH ANNUAL EMPOWERING DIVERSITY SCHOLARSHIP, PCMH PROGRAM DELIVERS HEALTHIER PATIENTS AND HAPPIER PROVIDERS. We offer a wide choice of individual plans to fit your health needs and budget. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. %PDF-1.5 % Account Specific Prefix are assigned by BCBS to national accounts. q8-_?UT"X e+1?#7DMKHY]?R,-e;PE\mL So, all BCBS plans, including Anthem prefix and Non-Anthem plans announced that member IDs will also be Alpha Numeric from 2018 onwards. For providers and medical billers who are performing medical billing services, BCBS alpha prefix are helpful to identify the correct payer ID and address for claims submission. 777 0 obj <>stream Blue Cross and Blue Shield of Illinois, P.O. K8Z : Page 2 . Independence Blue Cross (BC) of Philadelphia (Phi) and the Southeastern Pennsylvania (PA) PAI. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing, Empire Blue-Cross Blue-Shield of New York, Anthem Blue-Cross Blue-Shield of Kentucky, Maryland/District of Columbia/Northern Virginia, Highmark Blue-Cross Blue-Shield of Pennsylvania, Anthem Blue-Cross Blue-Shield of Connecticut, Anthem Blue-Cross Blue-Shield of Colorado, Anthem Blue-Cross Blue-Shield of New Hampshire, Anthem Blue-Cross Blue-Shield of Missouri, Blue-Cross Blue-Shield of Western New York, Independence Blue-Cross of Philadelphia and Southeastern Pennsylvania, Anthem Blue-Cross Blue-Shield of Virginia, Excellus Blue-Cross Blue-Shield of New York, Anthem Blue-Cross Blue-Shield of Wisconsin, Highmark Blue-Cross Blue-Shield of West Virginia, Horizon Blue-Cross Blue-Shield of New Jersey, Highmark Blue-Cross Blue-Shield of Delaware. nKvo2>)*Y=}4i,+s[yL*2#kN@r115};|`R[5/iZ Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. See the Medical oncology prior authorization list for Blue Cross and BCN commercial members for a supportive care drugs (other than CAR -T comprehensivelist of managed by AIM, and groupsincluded in the program. BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. So the next time you need to identify accurate BCBS prefix home plan, remember to use the BCBS prefix list lookup finder. BCBS Prefix will not only have numbers and the digits 0 and 1. First, it saves you time and hassle by allowing you to quickly identify correct BCBS insurance home plan without having to call customer service. %PDF-1.6 % The purpose of this list is to assist WA and AK providers to determine plan [PDF] CareFirst Third Party Administrator (TPA)/Network Lease Accounts Prefix. The prefix routes eligibility/benefits inquiries and claims to the appropriate BCBS Plan or system for timely processing. T. he Summary of Benefits and Coverage (SBC) document will help you choose a health. There are two types of BCBS prefixes which are mentioned below: Plan Specific prefix are assigned by BCBS to each plan. Always make sure to submit claims to insurance company on time to avoid timely filing denial. 'MNiXG]dRBC; 0'Va~9&c}Ag$Pge;\UY,$MtN Do not create one or use the BCBS prefix from another member ID card. We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan information. In addition, some sites may require you to agree to their terms of use and privacy policy. Member ID cards with no prefix Some member ID cards may not have a prefix. BCBS Alpha Prefix are not only important to identify BCBS health insurance member but they are also very important for electronic submission of claims to the correct BCBS plan. BCBS Alpha prefix are the three characters at the start of each BCBS insurance member ID. Save my name, email, and website in this browser for the next time I comment. What If BCBS Member ID doesnt have Prefix mentioned on Card? %%EOF Search for doctors near you and in your network. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). First Character Z assigned to the BCBS Plan. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. BCBS Prefix will not only have numbers and the digits 0 and 1. In the District of Columbia and . Last updated: 07/01/2022. 1 of 7. What is Medical Billing and Medical Billing process steps in USA? endstream endobj startxref I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. Check any internal documents you may have and update any references of "alpha prefix" to "prefix". BCBS prefix are easy to identify using our BCBS prefix lookup because they're part of every BCBS member ID and we included all of them here in the BCBS prefix list. PPO 837P Prefixes are also applicable, . Due to the exceeding number of BCBS insurance members, Alpha-Only Prefix member IDs exhausted. You may also be interested to read about denial code 27 reason and solutions. By knowing the details of BCBS home plan, including BCBS insurance plan benefits, coverage options, and costs, you can make better decisions about your healthcare needs. CareFirst IDs have plan codes 080/580 and 190/690. The first two characters of such BCBS prefix spots member plan and the third character is to identify the type of product in which the BCBS member is enrolled. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists 15456 0 obj <>stream But dont worry because our BCBS prefix finder include alpha numeric prefix information as well. Choose My Signature. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 800-676-2583. Final Remarks about BCBS Prefix Lookup Directory. 1254 0 obj <>/Filter/FlateDecode/ID[]/Index[1229 40]/Info 1228 0 R/Length 122/Prev 219460/Root 1230 0 R/Size 1269/Type/XRef/W[1 3 1]>>stream Have a look at our BCBS alpha prefix and BCBS alpha numeric prefix directory below. . Please DO NOT randomly select a three-character prefix. What is Medical Billing and Medical Billing process steps in USA? Each BCBS alpha numeric prefix represents different BCBS home plan. BCBS prefix is a three character prefixes followed by the id number except for the following products and programs. Born in Texas, USA. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. TT$%b"Dg!h^`]-ce?i8xRiu1IrD-%oR#yt;JBOJ#"TXwD0L Fw,]xS_CU3zf]06_T} PNGCqWV^UET6X~`U Note: BCBS FEP (Federal Employee Program) ID starts with the alphabet R follow by the insured ID number (For Example: R987654321). For Example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU etc. $=0j]xkM#[f4YgI|in Z(0zF1-9gk!D @WeUUn/R%$'c|J6:z}\}8ZNd+SL5-h"\wE$w{3\zO>,Vta$a`D7rHmr$bwZm7yYO)&^E<2@9#&UDOz The member ID number may be different for each member covered under the same policy, and it is typically used when seeking medical services, submitting claims, or accessing healthcare benefits. endstream endobj 742 0 obj <. hb```I! Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. The prefix may also route claim status inquiries and remit searches. To view this file, you may need to install a PDF reader program. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. Blue Shield (BS) of California. In case, you need any additional information related to BCBS prefix then feel free to reach out to us. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. BCBS is one of the biggest insurance companies in USA and serving more than 106 million people. PAJ. Additionally, the following services require Prior Authorization regardless of place of service or level of care: To submit a prior authorization request you may also fax or mail your request. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. For example: A2A12345678 Here " A2A" is BCBS alpha numeric prefix. BCBS Alpha Prefix Its a three letter alpha prefix followed by id number. Northwest Arizona Employee Benefit Trust (NAEBT) Group # 037461 . Please look for instructions or a phone number on the back of the member ID card. Always use the BCBS prefix on the members current ID card followed by the member id number. Correct BCBS home plan can easily be identified using our BCBS prefix lookup directory. Prefix ZGP identifies Blue Cross Blue Shield of Texas PPO Product. So, to answer this query, we have mentioned below few important points to consider. For example: ABC12345678 Here " ABC" is BCBS alpha prefix. And to manage such a big network, they divided it into different departments state wise or employer specific. Three-Character Prefixes. 741 0 obj <> endobj Here Letter R indicates BCBS FEP prefix. Suppose assume claims filed with an incorrect member ID number or BCBS prefix by Provider or Billing companies, then BCBS insurance will deny the claim stating Incorrect member ID, please submit with an correct member ID number. Benefits and eligibility should be verified for all members prior to rendering services. B}hJu`n+Z9>)2B~feo,TV [ZI^ylRr8DGo;ckrA;X2SjUlW]$4_vN(Tvh6#moc0!pbJ;oW)A'oR&bH=`1K}P(u3gD9:#1!m2saW1SD5/p2 'Su &x@`N.e#U(Fne]4;$"o*k;$~gn-Sd"mjdTY2R*I:w8w3;fpCfQH& A2Z, G2A, J4K etc. Individuals & Families We offer a wide choice of individual plans to fit your health needs and budget. Use this guide to see prior approval information for members with ID card prefixes: AEE, AXC, EXX, XCB, XCQ, XCR View guides [pdf] Medicare plans Learn more about providing care for Medicare members. Does BCBS policy number same as BCBS member ID number? bcbs prefix list PDF,Doc ,Images [PDF] Common Prefix Portal List PBC Premera Blue Cross Three Character Prefixes. Independence Blue Cross* Quick Reference Guide . Customer Service: 1-800-409-9462 HCSC-PORT. 1268 0 obj <>stream The following summaries and related prior authorization lists were posted on the Support Materials (Government Programs) page as of Jan. 1, 2021: Important Reminder: Check Eligibility and Benefits First Prefix UTS assigned to University of Texas. therapy) The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Narrow Network: Provider participation is by invitation. We have the right plan for you to keep you and your family covered. 0t9~pE_ >if}~t~iM 'yn8Pgi |hxQD_Y. Box 7930 Philadelphia, PA 19101-7930 Contact us to learn how we can improve your revenue cycle. BCBS of Illinois (IL) PAK. Third, it can help you make more informed decisions to choose right insurance plan and benefits. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. e@'SZD/KCbv*pKq~ The site may also contain non-Medicare related information. b(f{YH^tn}u62\}TgT>ENWJB=J #=a$oXIq(n,tU+D'j}L(t#,w?!^oZUQR, 7a. Box 805107, Chicago, Illinois 60680-4112. The SBC shows you how you and the plan would share t. he cost for covered health care services. Although we regularly update the BCBS Prefix information but in case youre unable to get information about correct BCBS plan from our BCBS Prefix lookup, feel free to contact us OR call BCBS directory phone number at 800-676-2583.

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