There is a balance due to us at the end of the payment cycle. | YUV SG ON Exchange Also its not a sequential order hence its hard to find unless we check with first 3 alpha prefix. You can use Availity to submit and check the status of all your claims and much more. 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. All the information are educational purpose only and we are not guarantee of accuracy of information. Provider: send us the member's medical records for this claim. Empire BlueCross moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015. AAU Blue Shield of California Featured In: May 2020 Empire Provider News. 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. ), Tel:800-562-1011Fax: 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), Premera Blue Cross - FEPPO Box 33932Seattle, WA 98133, Retail Pharmacy Program The main identifier for out-of-area members is the alpha prefix. 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. If you have questions, please contact your local Blue Cross and Blue Shield company. Completion of the credentialing process takes 30-60 days. ** Members who are part of the FEP will have the letter R in front of their member ID number. We will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. We will notify you once your application has been approved or if additional information is needed. AII BCBS of Louisiana This procedure is considered cosmetic. QMB SG ON Exchange When you go to this page, you should see a dialog box that asks for your ZIP code. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. national customer service numbers at fepblue.org, Espaol | The Level I Appeal must be submitted within 365-days following the action that prompted the dispute. Mail the overpayment amount to our finance department (address on check) along with a completed Refund Request form, or. DJF Anthem BCBS of Virginia Learn more about global periods, modifiers, virtual care, unlisted codes and NCCI bypass modifiers. Postal Prescription Services Online: Your PPS account Phone: 1 (800) 552-6694 TRS: 711 Fax (for providers only): 1 (800) 723-9023 DJK Empire BCBS 10/18) v2. We are now processing credentialing applications submitted on or before March 6, 2023. You can find a claim by the members ID number or by the claim number. 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. Supplier Registration the lookout for future communications with more information about this exciting enhancement for submitting claim appeals through . Box 52890Bellevue WA 98015 or fax at 1-866-458-5488. 0000014071 00000 n CVT Anthem Blue Cross of California 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. . ABB BCBS of IL The claim(s) will suspend and a processor will review to determine whether to send an Incident Questionnaire (IQ) to the member. Saturday 7 a.m. to 8 p.m.; Sunday 7 a.m. to 7 p.m. (Pacific)Calling from outside the US: Dial exit code of your country (typically 00) plus the country code (1 for USA), then the area code (916), then the seven-digit US local phone number 635-7373. CWE BCBS of Michigan It is critical for confirming a patients membership and coverage. APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 January 19, 2022 by tamble. For most plans, we'll deny claims received more than 12 months after the date of service with no member responsibility. AFZ Anthem Blue Cross of California Use our onboarding resource to quickly get started. We are unable to quote a benefit by a diagnosis or procedurecode. 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 PO Box 52057 ACU Anthem Blue Cross of California 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. 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 In general, there are two categories of alpha prefixes namely account specific and plan specific alpha prefixes. New York, New York 10008-3876. CVV Anthem Blue Cross of California CZU Anthem Blue Cross of California CWH Anthem Blue Cross of California Regence BlueShield - FEP PO Box 1388 Lewiston, ID 83501 Customer Service. ** Make copies of the front and back of the members ID card and pass this key information on to your billing staff. 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 Box 805107 Chicago, IL 60680-4112 Iowa . TINs are still a required element for claims. ), 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. 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 . We can't process this claim until the questionnaire we recently sent the member is completed and returned to us. Western WA providers submit claims to Regence Blue Shield. Franais | 0000011774 00000 n Thank you for choosing Regence as your health plan administrator. Blue cross Blue Shield association cannot accept Guest Membership claims electronically. Provider: send us the NDC #, quantity and date span for this claim. Kreyl Ayisyen | In some contracts, we use a RBRVS methodology, developed by CMS, to calculate its fee-for-service fee schedule. We can process the claim after we receive that information. Bellevue, WA 98004, Terms of Use | Privacy| Disclosure Notice Patient Protection Surprise Billing, An Independent Licensee of the Blue Cross Blue Shield Association Serving Select Counties in Washington. Identifying members Easily identify the kind of coverage our members have. CVG BCBS of Florida CYK BCBS of Georgia They can use such copies in different situations and get the complete support on time as awaited. Receiving payment Prescriptions. Washington Regence Blue Shield (800) 552-0733 (Member) (877) 668-4651 (Provider) (800) 344-2227 (866) 873-9743: Wisconsin (800) 242-9635 (800) 860-2156 (800) 424-4011 (800) 711-2225: If there are no court decrees, the plan of the parent with custody is primary. Filing your claims should be simple. ** Blank, or empty suitcase logo. providers: We process your claim as soon as we receive them. CWA Carefirst BCBS Washington DC We can process the claim after we receive that information. This includes QMA SG OFF Exchange, PPO YDX Retail ON Exchange You can submit claims daily, weekly, or monthly. AEM Highmark BCBS CWJ BCBS of Alabama DJC Anthem BCBS of Ohio medical equipment supplier, ambulance services, applied behavior analysis services (ABA) or clinical social worker. Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. When the conversion factor is multiplied by the total RVUs, it will yield the reimbursement rate for the specific service (or code). Please treat these members the same as domestic Blue Plan members. If you are interested in purchasing a new computer system, ask us for a list of vendors that submit claims to us in the HIPAA standard ANSI 837 format. ADL Anthem BCBS Kentucky 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 This plan allows you to self-refer. 598 0 obj <>stream The revenue codes and UB-04 codes are the IP of the American Hospital Association. Tennessee. We can't process this claim until the incident questionnaire we sent the member is fully completed, signed and returned. 1-800-962-2731. 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). In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. 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. Continue to submit paper claims until you are told to stop. 24/7 Nurse Line: 800-267-6729. 0000014956 00000 n Your Claims & Eligibility. You may request to have a customer service representative call you at a scheduled time during normal business hours for plan help. 4. However we have some guide to follow, using prefixes we could find the state of the BCBS and contact phone number to proceed further. 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. Provider who rendered the service. Below you will find a list of the 2015 BCNEPA plans with the corresponding Highmark Blue Cross Blue Shield plans for 2016. To make tracking patient reimbursement easier, we can include these account numbers on our payment vouchers. ABE BCBS Minnesota A comprehensive list is posted in the Library under Reference Info. Completion of the credentialing process takes 30-60 days. ABY Carefirst BCBS Maryland BCBS Provider Phone Number. *Follow instructions on these ID cards to verify eligibility, submit claims and obtain health plan contact information. AHI BCBS of Rhode Island ), claims will be processed accordingly and under the terms of our subscriber's contract. | Diabetes. AIA BCBS of Texas Asthma. CVZ Horizon BCBS of New Jersey CZK Anthem BCBS of Virginia 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. CVC Anthem BCBS of Ohio Review our pricing disputes and appeals information to ensure you are following the correct process. Were ready. In third-party cases, this provision permits the plan to recover the medical bill costs on behalf of the member. Ting Vit | BCBS Prefix List 2021 - Alpha. Any suggestions. BCBS Provider Phone Number. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Unclean claims will begin to A Level I Appeal is used to dispute one of our actions. 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. | The provider needs to submit itemized charges to us. Church Street Station. CYJ Horizon BCBS of New Jersey Care Management Programs. When a member is the subscriber on more than one plan, when both plans have a COB provision, the plan with the earliest start date pays first (primary). Please review the terms of use and privacy policies of the new site you will be visiting. Eastern WA and Alaska providers submit to Premera. . FAQs & Resources What type of EDI transactions does RGA accept? To contact us without setting your ZIP code, call: Prescription questions?Call Customer Service and choose the Pharmacy option. (BlueCard will request refunds regardless of the dollar amount.) P | ALN PA BC PA, Highmark, POB 1210 , Pittsburgh , PA , 15230 800-433-9906 (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10. 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. Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. Please reach out and we would do the investigation and remove the article. If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. YDO Retail OFF Exchange Phoenix, AZ 85072, Phone:800-562-1011 Completion of the credentialing process takes 30-60 days. As members renew or enroll their individual or group contracts for health care coverage in 2016, they will be presented with a new Highmark branded ID card. Subrogation permits the plan to recover payments when the negligence or wrongdoing of another causes a member personal illness or injury. 0000018992 00000 n For more information about RBRVS methodology visit the CMS website. All Rights Reserved to AMA. Regence BlueShield. AGH Anthem Blue Cross of California Phone:800-562-1011Fax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals)Fax: 866-948-8823 (FEP Care Management - prior auth/pre-service requests), Email: 1-800-423-1973. This standard is called the "Birthday Rule.". If you find anything not as per policy. 553 0 obj <> endobj Lastly mail the completed claim form to the address provided. Uniform Medical Plan (UMP) offers you five different health plans through Washington state's Public Employees Benefits Board (PEBB). AIE BCBS of Michigan Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. Our provider complaints and appeals process ensure we address a complaint or an appeal in a fair and timely manner. From there, you will be directed to a new site; at this site, enter in your login information, if you are not registered, please click on the Not Registered link to set up your account information. Claims & payment Claims and payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. 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. Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 We use cookies on this website to give you the best experience and measure website usage. 0000013357 00000 n CYQ BCBS of IL Provider: send us medical records relating to prescription drug charges. 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). 24/7 anonymous hotline: 1 (800) 323-1693 Medicare Part C & D: 1 (800) 633-4227 Online reporting form Ethics & compliance hotline You can remain anonymous. DJN BCBS Minnesota We will notify you once your application has been approved or if additional information is needed. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). the claims for which interest payments have been applied during that period. Check out the changes and updates to our plan in 2023. Regence Uniform Medical Plan Vision Claim Form - An ERISA Section 502 (a) prepare can be reported in many different methods. Regence Group Administrators offers a complete suite of health risk management services in addition to benefit administration. KingCareSMuses a preferred provider organization (PPO) for its network. Always use the alpha prefix on the members current ID card. CZW BCBS of North Carolina If you have questions about COB, contact Customer Service by calling the phone number on the back of the member's ID card. This is a claim adjustment of a previously processed claim. Provider: please send us the radiology reports for this claim. ADM BCBS of IL Access fee schedules. Membership Address. The three characters preceding the subscriber identification number on BCBS member ID cards. Regence Blue-Cross Blue-Shield: YAM-Unallocated/Not Assigned: YAN-Unallocated/Not Assigned: YAO-Unallocated/Not Assigned: YAP: Minnesota: View the instructions for verifying your information and notifying us of changes. BCBS Prefix List 2021 - Alpha. HMO products include BlueChoice HMO, Direct Connection HMO, Child Health Plus, BlueChoice HMO/POS and Direct POS. Provider: please send us your operative notes for this claim. Mental Health/Substance Use Disorder Precertification. Note: When submitting an email inquiry, please include your tax identification number (TIN) and/or Organizational NPI number. Call 1 (855) 522-8894. 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. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. We recommend that you make copies of everything that is submitted for your personal records. Your office staff can then post this remittance manually or electronically (if your software has electronic posting capability). 398-0520-PN-NY. AHB Anthem BCBS of Ohio CYS BCBS of IL CUQ Blue Shield of California All of our contracts exclude coverage for care covered under the Workers' Compensation Act. 0000004602 00000 n PO Box 3876. https://drive.google.com/file/d/0Bzbk78qiF4H_ZU9NTmxSenJwb0U/view?usp=sharing, Nice to know, this should be useful as a reference, I'm just looking for the alpha prefix reference list for OHIO but all I keep getting is other states. Box 91102 State Lookup. 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. Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. QMF Retail ON Exchange Chronic Obstructive Pulmonary Disease. If you need more information about the NPI mandate, Medicare timelines, and/or the enumeration process, visit the CMS website. CWQ Anthem BCBS of Ohio See our FAQs for more claim information and contacts. ABK Carefirst BCBS Maryland You must request mediation in writing within 30 days after receiving the Level II appeals decision on a billing dispute. YDM SG Off Exchange Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. AHX Horizon BCBS of New Jersey 0000056226 00000 n State Lookup. Jun 29, 2010 | Medical billing basics | 6 comments. ABL BCBS of IL When a dependent is double-covered under married parents' health plans, the primary plan is the coverage of the parent with his/her birthday earlier in the year, regardless of their actual age. Invalid claims are reported back to the provider with rejection details. Empire BCBS Phone Number and Claim Address (2023) BCBS Alpha Prefix IAA-IZZ (2023) BCBS Alpha Prefix HAA-HZZ (2023) BCBS Alpha Prefix List GAA-GZZ (2023) A Level I Appeal is used for both billing and non-billing issues. Access eContracting to view and sign agreement documents. ADG Anthem BCBS of Ohio Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. 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. Calypso, our affiliate, processes refunds and overpayment requests. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. The claim will be reprocessed and reflected on the payment voucher. Blue Cross Blue Shield Federal Phone Number. View your credentialing status in Payer Spaces on Availity Essentials. Claim Forms; Get to know your member ID card. You can make a complaint verbally to Customer Service or in writing to Customer Service Correspondence. For general inquiries and questions about the Service Benefit Plan, our overseas and pharmacy coverage or fraud assistance, you can call us toll-free nationwide. AGF Anthem BCBS of Ohio Box 3004 Naperville, IL 60566-9747. Box 33 Enter the contract name of physician or provider who performed the service. . 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. CZM Highmark BCBS The member or provider can submit the completed IQ using one of the following methods: The member may contact Customer Service (the number is on the back of the ID card) to update IQ information over the phone. This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. 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
