Precertification remains the responsibility of the provider for all Empire HMO network members. We notify you in writing if the request for mediation is not timely. APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 See our FAQs for more claim information and contacts. Contact us - Regence CYN Highmark BCBS If you're a medical biller or a provider and going to submit BCBS plan member claim to the insurance, make sure to submit member ID including prefix. Below is a list of the old and new alpha prefix codes. DJW Wellmark BCBS Iowa/South Dakota trailer AGR Anthem BCBS of Colorado PDF Local Blue Cross and Blue Shield Mailing Addresses State/Alpha Prefix 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. CVC Anthem BCBS of Ohio How to Submit a Claim - FEP Blue YUV SG ON Exchange You may have invested in the account specific alpha prefix health insurance plan from BSBS at this time. Provider: send us the NDC #, quantity and date span for this claim. 0000055309 00000 n Heres everything you need to know about it. 1-877-764-8724 Email Us. AAB BCBS of Michigan Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. The time period does not start until we receive a complete appeal. Call Customer Service and choose the Pharmacy option. providers: We process your claim as soon as we receive them. Regence Provider Appeal Form. We need the member to promptly complete and return this questionnaire to process claims in a timely manner. AAU Blue Shield of California Receiving payment View the toolkit Claims submission Enter the three digit alphanumeric prefix located on the member's ID card, and the tool provides the correct insurance carrier for you. You have to bear in mind that the alpha prefix has three letters usually followed by the identification of member of BCBS. The protection of your privacy will be governed by the privacy policy of that site. 0000015111 00000 n Provider: please send us the radiology reports for this claim. All the information are educational purpose only and we are not guarantee of accuracy of information. . BCBS Company. 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. CUU BCBS of Texas ADM BCBS of IL CWQ Anthem BCBS of Ohio In general, there are two categories of alpha prefixes namely account specific and plan specific alpha prefixes. Need help with a claim? If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. 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. | It doesn't replace your tax ID number (TIN) or Drug Enforcement Administration (DEA) number. Log in to Availity Don't have an Availity account? 0000087176 00000 n 3. Need help with a claim? Blue Advantage Administrators of Pay or deny 95 percent of a provider's monthly volume of all claims within 60 days of receipt. Provider who rendered the service. Lack of credentialing can be grounds for termination from Premeras network. Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out. We will notify you once your application has been approved or if additional information is needed. Policy #s: Regular10017241-0001, Transit10017241-0004, Sheriff10017241-0016, Chinook Building Alaska contracted and non-contracted Congestive Heart Failure. Claims & payment Claims and payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. We can process the claim after we receive that information. AAY Wellmark BCBS Iowa/South Dakota 398-0520-PN-NY. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). Please review the terms of use and privacy policies of the new site you will be visiting. Thank you for the care you provide to our members and people in our communities. There is a minimum threshold of $25 for monthly interest payments on delayed clean claims. Prefix Plan Name, AAA BCBS of Alabama Tagalog | Please reach out and we would do the investigation and remove the article. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Use the following codes: In the Original.Ref.Co segment of box 22 enter the original claim number. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. 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. We can't process this claim until the questionnaire we recently sent the member is completed and returned to us. Medical claims. CWF BCBS of Georgia News. It is critical for confirming a patients membership and coverage. 1-800-423-1973. Briefly, these rules are as follows: Some group contracts are not subject to state regulations may have unique COB rules that could change the order of liability. Claims submitted that indicate possible Workers' Compensation illness or injuries are investigated. The mediator consults with the parties, determines a process, and schedules the mediation. Empire BlueCross moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015. CWH Anthem Blue Cross of California Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. AGX Anthem BCBS of Virginia The main identifier for out-of-area members is the alpha prefix. 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. treatment center. Blue-Cross Blue-Shield of Tennessee. New York, New York 10008-3876. 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. the claims for which interest payments have been applied during that period. You can learn more about credentialing by visiting the provider section of our website. Your member ID card is your key to using your medical plan benefits. DCL BCBS of TN 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: 0000128769 00000 n January 19, 2022 by tamble. We use cookies on this website to give you the best experience and measure website usage. You can make a complaint verbally to Customer Service or in writing to Customer Service Correspondence. DBT BCBS of Michigan AAN Anthem Blue Cross of California They will be satisfied when they properly use this insurance plan and fulfil overall requirements on the prompt assistance for claiming the insurance. Provider home - Regence 0000008643 00000 n Centers of Excellence Program administered by Premera Phone: 1 (855) 784-4563 TRS: 711 Business hours: Monday through Friday 7 a.m. to 5 p.m. (Pacific), Puget Sound High Value NetworkPhone: 1 (855) 776-9503TRS: 711Business hours: Monday through Friday 7 a.m. to 7 p.m. (Pacific), UW Medicine Accountable Care NetworkPhone: 1 (888) 402-4237TRS: 711Business hours: Monday through Friday 5 a.m. to 8 p.m. (Pacific). Michigan. AEK Independence Blue Cross BCBS Prefix List QAA to QZZ - Alpha Lookup by State 2022 1-800-676-BLUE (2583) (toll free) Blueline voice response unit. Regence BCBS Oregon: YVK: Not Assigned Prefix: YVL: Regence BCBS Oregon: YVM: Regence BCBS Oregon: YVO: Regence Blue Cross Blue Shield Oregon: YVP: . Contact Provider Relations | Blue Cross of Idaho - bcidaho.com The alpha prefix identifies the Blue Plan or National Account to which the member belongs. If submitting a corrected claim on paper, remember to: Obtain Corrected Claim - Standard Cover Sheets at onehealthport.com in the administration simplification claims processing section, or under Forms on our provider website. AFG BCBS of Nebraska Unclean claims will begin to 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). Open 24 hours a day, 7 days a week. note: Exclusions to paying interest may apply based on line of business. UMP PEBB | Contact us - Regence Use only red CMS-1500 forms (no photocopied forms). Open 24 hours a day, 7 days a week. How do I determine if a diagnosis or procedure code needs preauthorization? YDZ SG OFF Exchange PDF State Mail to Mailing Address City, State Zip - Pnnl xref Facility Services are services received for the use of a facility such as a hospital, emergency room, freestanding ambulatory facility, attended sleep study at outpatient part of a hospital, alcohol treatment facility or residential AEZ Wellmark BCBS Iowa/South Dakota All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. If the information is not captured correctly, you may experience a delay with the claim processing. Open 24 hours a day, 7 days a week. . Provider: please send us your operative notes for this claim. If there are no court decrees, the plan of the parent with custody is primary. 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. ABD Blue Shield of California 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. 0000013357 00000 n CVZ Horizon BCBS of New Jersey | The three characters preceding the subscriber identification number on BCBS member ID cards. endstream endobj 554 0 obj <>/Metadata 28 0 R/Pages 27 0 R/StructTreeRoot 30 0 R/Type/Catalog/ViewerPreferences<>>> endobj 555 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 203>>/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 556 0 obj <> endobj 557 0 obj <> endobj 558 0 obj <> endobj 559 0 obj <> endobj 560 0 obj <> endobj 561 0 obj <> endobj 562 0 obj [591 0 R] endobj 563 0 obj <>stream 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. When members of Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. View the instructions for verifying your information and notifying us of changes. We accept electronic claims through Availity using payer ID RGA01. 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. Polski | Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. It is critical for confirming a patients membership and coverage. 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. Correspondence. Continue to submit paper claims until you are told to stop. You can get the standardized coverage from this health insurance plan all through the nation. ADT BCBS Minnesota Identifying members Easily identify the kind of coverage our members have. Contact us - Regence For more specific contact information, choose from the following: Individuals and families Medicare Employers Producers Providers Fraud or abuse You can remain anonymous. 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 0000005825 00000 n ABR Carefirst BCBS Maryland The provider needs to submit itemized charges to us. AFA Anthem BCBS of Virginia AAQ Anthem BCBS of Ohio CVK BCBS of Florida Please refer to the members ID card to determine if he/she has one of these products. CZE Anthem Blue Cross of California Our medical staff reviewed this claim and determined that this admission doesn't meet the criteria for medical necessity. QMC Retail OFF Exchange hb``d``3g`c`P`eb@ !GCPI+""hr^eA ewJ?hx2-H IM:^7I,y ZPPTP J ! X,/ !q77p0P&{'LYr000 Our provider complaints and appeals process ensure we address a complaint or an appeal in a fair and timely manner. AFL Anthem Blue Cross of California Claims & payment - Asuris There is other activity on your account during the payment cycle. Eligibility, enrollment, and address/name changes. BCBS Prefix List 2023 - Alpha Prefix and Alpha Number Prefix Lookup A Level I Appeal is used for both billing and non-billing issues. They include a request of medical records for review. Do not make up alpha prefixes or assume that the members ID number is the Social Security Number. You can also submit claims via mail to our claims address P.O. Regence Uniform Medical Plan Vision Claim Form color, national origin, age, disability, sex, gender identity, or sexual orientation. CZR Wellmark BCBS Iowa/South Dakota You can also call using Skype. ABE BCBS Minnesota If you are unable to submit claims electronically, you can submit paper claims on CMS-1500 or UB-04 forms. To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. CWR Anthem Blue Cross of California CYS BCBS of IL 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. ), 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 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. ), 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. ABQ Blue Cross of Idaho (Boise) If we receive the complaint before the 365-day deadline, we review and issue a decision within 30 calendar days via letter or revised Explanation of Payment. DAU Anthem BCBS of Missouri CZC Anthem BCBS of Ohio ADQ Independence Blue Cross To contact us without setting your ZIP code, call: Prescription questions?Call Customer Service and choose the Pharmacy option. Filing your claims should be simple. AEG Anthem BCBS of Ohio They can use such copies in different situations and get the complete support on time as awaited. Get help when you need it. National Correct Coding Initiative (NCCI) editing is followed when applicable. 0000014071 00000 n Contact us for health care providers Contact us for healthcare providers.

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