), 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. https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. 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. If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). claims status, . The plan mailing addresses are available on our website under Contact Us. 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. Call 1 (855) 522-8894. ** When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the members card. DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. CYJ Horizon BCBS of New Jersey information. 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. DHB Empire BCBS Its often confused that BCBS have lot of prefixes and where to contact. This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. ADF Healthnow of NY Buffalo 0000000016 00000 n 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: Electronic claims without a TIN are rejected as incomplete. Caused by another party (e.g., slip and fall, medical malpractice, etc. Note: When submitting an email inquiry, please include your tax identification number (TIN) and/or Organizational NPI number. Complaints received beyond the 365-day timeframe will not be reviewed and the appeals rights pertaining to the issue will be exhausted. ), 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 QMF Retail ON Exchange Atlanta, GA 30348-5557. Medical claims. ** A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total. What is an 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. ABU BCBS Minnesota Supplier Registration Availity supports the exchange of electronic remittance advice (ERA) files for Regence payers in the ASC X12 835 format. P.O. STATE MAIL TO MAILING ADDRESS CITY, STATE ZIP Alabama Blue Cross and Blue Shield of Alabama 450 Riverside Parkway E Birmingham, AL 35298 . 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. AEM Highmark BCBS Your account number can be included in box 26 (Patient's Account Number) of the CMS-1500 form whether you submit electronically or on paper. ACX BCBS of IL CVA Anthem BCBS of Ohio They must be sent hard copy. All Rights Reserved to AMA. ABF Healthnow of NY Buffalo 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. ACS BCBS of IL Before discussing member claim information, the Customer Service representative must verify the identity of the caller. 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. DAC BCBS of Tennessee All the information are educational purpose only and we are not guarantee of accuracy of information. 0000003471 00000 n Paper Claim Form . Franais | 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. If submitting a corrected claim electronically, remember to: For additional instructions on electronic corrected, replacement or voided claims, visit the online section Electronic Transactions and Claim Payer ID, for additional For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. ** Empty suitcase logo, for eligible Manage Care/POS, Traditional and Managed Care/HMO members. This includes CZM Highmark BCBS 0000015026 00000 n For more information, view our privacy policy. Regence BlueShield Attn: UMP ClaimsP.O. EMPIRE BCBS Decides the pre certification requirements based on the prefix id. 1 (888) 675-6570 Prescription questions? To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. We can process the claim after we receive that information. 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. 1fcZi=s6Z@n7;W^ugC:CGLi@0^pQY4#o0 y>_ DJJ Horizon BCBS of New Jersey ABK Carefirst BCBS Maryland Box 21267 M/S S518 Seattle, WA 98111-3267 Claims appeals, balance billing or pricing disputes The process for submitting an appeal depends on your issue. Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. CWI Blue Shield of California You will need special software to send insurance claims electronically. Washington Contracted Providers: If we fail to satisfy either of the above standards, well pay interest on each claim that took longer than 60 days to process at a 12 percent annual rate (unclean days are not applied toward the 60 day calculation). 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. 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 . Empire BlueCross moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015. AHJ Independence Blue Cross Special Message: Coming soon, you will be able to dispute (appeal) a claim on Availity from the claim status result page. 0000004073 00000 n FAQs & Resources What type of EDI transactions does RGA accept? Please review the terms of use and privacy policies of the new site you will be visiting. COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. This is a claim adjustment of a previously processed claim. ** Remember: Member ID numbers must be reported exactly as shown on the ID card and must not be changed or altered. This plan allows you to self-refer. Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. We follow industry standard coding recommendations and guidelines from sources such as the CMS, CPT, and AMA, and other professional organizations and medical societies and colleges. Retirees and PEBB Continuation Coverage members:Phone: 1 (800) 200-1004TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). The ID cards also may have: DJC Anthem BCBS of Ohio Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. CZY BCBS of North Carolina Open 24 hours a day, 7 days a week. A fragmented or split professional billing is defined as professional services rendered by the same provider for the same date of service and submitted on multiple professional claim forms. Regence BCBS Oregon: YVK: Not Assigned Prefix: YVL: Regence BCBS Oregon: YVM: Regence BCBS Oregon: YVO: Regence Blue Cross Blue Shield Oregon: YVP: . Regence Blue-Cross Blue-Shield: PDS: Maryland/District of Columbia/Northern Virginia: Carefirst Blue-Cross Blue-Shield: PDT: Pennsylvania: Need information from the member's other insurance carrier to process claim. CVQ BCBS of Georgia 0000014956 00000 n AIH Anthem Blue Cross of California 0000018816 00000 n We also provide information regarding mediation should you disagree with the decision. CUR Healthnow of NY Buffalo DJR Anthem BCBS of Ohio QAB. Prescriptions. Where do I determine if a code is covered? 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. It doesn't replace your tax ID number (TIN) or Drug Enforcement Administration (DEA) number. Completion of the credentialing process takes 30-60 days. BCBS Provider Phone Number. BCBS Company. Diabetes. Bill all original lines-not including all of the original lines will cause the claim to be rejected. The mediator's fees are shared equally between the parties. Call Customer Service and choose the Pharmacy option. AEP Carefirst BCBS Maryland The conversion factor represents the dollar value of each relative value unit (RVU). Payment of this claim depended on our review of information from the provider. 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. AFL Anthem Blue Cross of California CWF BCBS of Georgia (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). AEF BCBS of IL In this health insurance plan, alpha prefix is assigned to national accounts. All services rendered by the same provider for the same patient for the same date of service must be submitted on one claim form. Prefix Product Area Billing Address Phone #, AAX CA BC CA, POB 60007 , Los Angeles , CA , 90060 800-765-2588, ABW VA BC VA, Trigon POB 27401, Richmond , VA , 23279 800-445-7490, ACN PA BC PA, Highmark BC PO Box 1210 , Pittsburgh , PA , 15230 800-682-3386, ACT NY BCBS Empire, POB 11800 , Albany , NY , 12211-0800 800-992-2583 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. Below is a list of the old and new alpha prefix codes. 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). CZK Anthem BCBS of Virginia Modifiers. CVX BCBS of IL (If no account number is assigned, the words No Patient Account # are noted. Claim edits in place will identify those services previously billed and bundle ALL services on to a single 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. 02/16/2023 Retirement Workshop in Lacey on Feb. 18. . Only appeals received within this period will be accepted for review. Coding toolkit View our clinical edits and model claims editing. Refund total overpayment amounts within 60 days of initial notice to avoid having outstanding refund amounts offset against future payments. If we need additional information for subrogation determine to pay or deny, the IQ will either be sent back to the member requesting the information, or subrogation will make two calls within five days of receiving the IQ. Provider: please send us your office notes for this claim. We will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. Filing your claims should be simple. It is critical for confirming a patients membership and coverage. accrue interest on the 31st day from receipt of the information. When two or more health plans cover a member, COB protects against double or over-payment. Doing so may cause delays in the handling of your inquiries and claims. Claims submission Learn more about billing and how to submit claims to use for payment. Federal Employee Program Overseas Claims P.O. A free form note with an explanation for the corrected/replacement claim, in loop 2300 claim note as: For professional and dental claims: segment NTE01 must contain ADD and segment NET02 must contain the note, for example: NTE*ADD*CORRECTED PROCEDURE CODE (or whatever data element was corrected/changed on the claim), For facility/institutional claims: segment NTE01 must contain UPI and segment NTE02 must contain the note, for example: NTE*UPI*CORRECTED LAB CHARGES (or whatever data element was corrected/changed on the claim), Premera Blue Cross Blue Shield of Alaska Participating (Traditional/Indemnity) and Preferred/BestCare (PPO), Dimensions (HeritagePlus, HeritageSelect, or Global), Validation to ensure that they are HIPAA-compliant, Detailed claim acceptance and rejection reporting. 24/7 anonymous hotline: 1 (800) 323-1693 Box 105557. CZZ Highmark BCBS AAK Anthem Blue Cross of California Identifying members Easily identify the kind of coverage our members have. We can process the claim after we receive that information. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. YUV SG ON Exchange APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 Once you have signed in, simply click on the Claim Search link. Please review the terms of use and privacy policies of the new site you will be visiting. Calypso, our affiliate, processes refunds and overpayment requests. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. Additional Contact Information Pharmacy Program. Contact. Premera Blue Cross Blue Shield of Alaska FEP PO Box 33932 Seattle, WA 98133-0932, Phone:800-562-1011 Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. They are identified by Guest Member on their health plan ID card. Our provider complaints and appeals process ensure we address a complaint or an appeal in a fair and timely manner. ABV Anthem BCBS of Ohio Also its not a sequential order hence its hard to find unless we check with first 3 alpha prefix. Ting Vit | To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. DAU Anthem BCBS of Missouri 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. AIE BCBS of Michigan It is important to file a claim with all insurance companies to which the member subscribes. AFA Anthem BCBS of Virginia $25 will continue to accrue until it reaches that threshold or until December of each year. ACL Anthem Blue Cross of California ACR Anthem Blue Cross of California AIA BCBS of Texas Claims Address. Regence Provider Appeal Form. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, 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. ** Verify with the member that the ID number on the card is not his/her Social Security Number. This claim is a duplicate of a previously submitted claim for this member. 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. Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out. Provider: please send us your operative notes for this claim. The claim will be reprocessed and reflected on the payment voucher. Below you will find a list of the 2015 BCNEPA plans with the corresponding Highmark Blue Cross Blue Shield plans for 2016. QME Retail OFF Exchange any missing required substantiating documentation or particular circumstances requiring special treatment. Regence Blue Shield in accordance with the terms of your provider contract with Regence. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. QMB SG ON Exchange ** The empty suitcase logo BCBS Federal Phone Number; Ambetter Claims address and Phone Number; Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit; Kaiser Permanente Phone Number . Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. That way, we can verify your account and start helping you as quickly as possible. YDO Retail OFF Exchange 1 (877) 878-2273 If you require a written refund request before mailing the overpayment, contact Calypso directly at 800-364-2991. . AAS Anthem Blue Cross of California 0000005570 00000 n ACD BCBS of Michigan Claim Forms; Get to know your member ID card. Remember to include the leading three-character prefix and enter it in the appropriate field on the claim form. On the other hand, the third character in the prefix is used to find out the product type you have enrolled in. Final Instructions about BCBS Prefix Lookup. CZP Anthem BCBS of Ohio CZE Anthem Blue Cross of California ACQ BCBS of Georgia AEA BCBS of Texas Your software vendor can help you set up your computer to accommodate Premera's billing requirements. Call Customer Service and choose the Pharmacy option. If member does not return the call, claims will be denied until information is received. BET PA BC PA, 120 Fifth Ave , Pittsburgh , PA , 15222-3099 412-544-7000, BFM PA BC PA Highmark, POB 176 , Pittsburgh , PA , 15230-0176 866-316-6339, BGH AL BCBS of Alabama, POB 995 , Birmingham , AL , 35298 205-988-2213, BGP MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BHP PA BC PA, POB 778988 , Harrisburg , PA , 17177-8988 800-222-3341, BIM MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BMI IN BCBS of Indiana, 120 Monument Circle , Indianapolis , IN , 46204 317-488-6000, BOG MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237

Dr Barbara Jenkins Biography, The Maine House Lake Christopher, Does Ensure Pre Surgery Drink Cause Diarrhea, Cryptopia Bitcoin, Blockchains And The Future Of The Internet, Michigan Electrical Code For Pole Barns, Articles R