EMPIRE BCBS Decides the pre certification requirements based on the prefix id. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. On the other hand, the third character in the prefix is used to find out the product type you have enrolled in. If you participate with the other Blue Plan, please submit claims directly to that other Blue Plan for processing. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. The total number of characters in the members ID ranges from six to fourteen. The resources on this page are specific to your state. AAY Wellmark BCBS Iowa/South Dakota ** Always include the members ID number, including the alpha prefix, on any documents pertaining to services to ensure accurate handling by the BCBS Plan. CYP BCBS of IL Wellmark BCBS of Iowa and South Dakota timely filing limit for filing an initial claims: 180 Days from the Date of service.Provider Forms. If the MEOB doesnt indicate that the claim was sent to the secondary carrier, submit it with the MEOB to: Before resubmitting a claim, check the status of your claim on NaviNet.net or call our Dedicated BlueCard Service Unit at 1-888-435-4383. Our services are covered in full by MOST network commercial health plans. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jerseys Health Insurance Marketplace. Member identification prefixes were updated as part of that transition. October 19, 2022 July 24, 2020 by medicalbillingrcm. The list below will help you identify members enrolled in an AltNet plan. You can obtain eligibility and benefits information for your BlueCard patients by phone or electronically. It looks like you're outside the United States. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. AEC BCBS of IL ABW VA BC VA YTX Anthem BCBS of Virginia YUA BCBS of Oklahoma YUB BCBS of Oklahoma YUD BCBS of Oklahoma YUF BCBS of Oklahoma CYW Anthem BCBS of Ohio After providing the prefix from the members ID card, youll be connected to the Customer Service team at the members Blue Plan. BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. 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. Out-of-network benefits apply to members who use other physicians, health care professionals or facilities, including physicians or health care professionals who participate only in our Horizon PPO Network. ID cards for the following products and programs do not have an alpha prefix: ** Stand-alone vision and pharmacy when delivered through an intermediary model*, ** The BCBS Federal Employee Program (FEP) The letter R appears in front of the ID number.*. ABQ Blue Cross of Idaho (Boise) CZY BCBS of North Carolina COMMERCIAL. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. Resident: Spouse: Name: None Listed: DOB: SSN: Include: Financial Institution: Name For questions about the BlueCard claim appeal process, call our Dedicated BlueCard Unit at 1-888-435-4383. 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 The member has access to the exchange PPO network, referred to as BlueCard PPO Basic. Welcome to BCBS FEP Vision. PPCP SSpecialist OVOffice Visit CCConvenience Care UCUrgent Care EREmergency Room Rx Deductible IND $100 Rx Out-of-Pocket IND $500 Medical In-Network Out-of-Network IND Deductible $1000 $4000 IND Out-of-Pocket $5000 $8000 Coverage IND P$0 S$30 CC$0 UC$50 ER30% RX PD PV ABV Anthem BCBS of Ohio Created Date: 10/16/2011 1:15:01 PM. Please update your browser if the service fails to run our website. Please use these forms to ensure faster processing time. Created Date: 10/16/2011 1:15:01 PM. YDO Retail OFF Exchange QMG SG OFF Exchange. 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. "Sinc AEQ BCBS of Michigan Claims with incorrect or missing prefixes and member ID numbers delay claims processing. Refer to your patients ID card for phone number information or call 1-800-664-BLUE (2583). In order to streamline our provider information management system and comply with the No Surprises Act (NSA) effective January 1, 2022, new provider change forms are now available. Please use this form when needing to update practitioner's affiliation to existing billing practice (assignment account). We are also licensed to use MCG guidelines to guide utilization management decisions. 1339. For additional information, view our page or the BCBS Association BlueCard program page. ACR Anthem Blue Cross of California There are three ID card elements you should look for to identify a BlueCard member: The presence of another Blue Cross and/or Blue Shield Plans logo on the members ID card means a member may be eligible for BlueCard benefits. WebWebWe're available by phone: (410) 657-8060. How to send paper attachment for Electronic claims? CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY, Top 13 denials in RCM and how to prevent the denials, Critical care codes Usage , Time, Documentation, Medical necessity condition with example. To help support the investigation, you can pull the corresponding error log from your web server and submit it our support team. AEX BCBS of IL 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 Call the appropriate Blue Cross and/or Blue Shield Plan for claim submission instructions. AEZ Wellmark BCBS Iowa/South Dakota The BCBSA has licensed them in a state or given geographic area to offer only certain products or services under the Blue Cross or Blue Shield brand name and symbol. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. CZF BCBS of Rhode Island You may also log in to NaviNet and use the BlueExchange option within the Eligibility and Benefits Inquiry capability. Our services are covered in full by MOST network commercial health plans. ABW Anthem BCBS of Virginia AGS Anthem Blue Cross of California The other plan will transmit the approval to us and we will issue reimbursement and an EOP to you. QMA SG OFF Exchange, PPO YDX Retail ON Exchange AEJ Horizon BCBS of New Jersey If prior authorization/precertification is required and not obtained for inpatient facility services, the facility will be financially responsible and the member will be held harmless. This form is used to assist in determining if a patient is eligible to receive Workers' Compensation, No-Fault Automobile or Personal Liability insurance benefits due to a possible accident or injury. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Please treat these members the same as domestic Blue Plan members. If the patients ID card does not include a prefix, check for a phone number on the card. When submitting a provider inquiry for review, please submit all materials as indicated within the form. Those who have a checking or savings account, but also use financial alternatives like check cashing services are considered underbanked. You can also visit bcbs.com to find resources for other states. You may like to substitute any prefix of BCBS with an existing BCBS. 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. Claim denial requiring additional information. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. 2. 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after COVID-19 Many doctors agree it's here to stay, Value-based care -- transforming health care with better collaboration and improved health outcomes, When planning, collaboration and crisis merge - a medical practice's successful response to COVID-19, Applicable Products:Commercial PPO/EPO &Exchange POS/EPO, Applicable Products: Commercial HMO & POS, Claims Payment Policies and Other Information, UAW Retiree Medical Benefits Trust (URMBT). Shop plans for Medicare, Medical, Dental, Vision & Employers. (previously the Provider Demographic Change Form), Participating Providers should utilize this electronic form to update name, address, phone number, email or web address, and specialty type for a practitioner or group. ** Do not add/delete characters or numbers within the member ID. ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. We currently don't offer resources in your area, but you can select an option below to see information for that state. ADA Anthem Blue Cross of California ABJ BCBS Minnesota CVZ Horizon BCBS of New Jersey Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Your dashboard may experience future loading problems if not resolved. It is critical to confirm membership, eligibility and coverage. ACV BCBS of Georgia There is an unknown connection issue between Cloudflare and the origin web server. The Blue Cross and Blue Shield name and symbols are registered marks of the Blue Cross Blue Shield Association. ACL Anthem Blue Cross of California The 2015 member identification prefixes for individual Medicare Advantage plans are listed below. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. AII BCBS of Louisiana The Braven Health Payer ID is 84367. However we have some guide to follow, using prefixes we could find the state of the BCBS and contact phone number to proceed further. YDZ SG OFF Exchange Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Hello, and welcome to Protocol Entertainment, your guide to the business of the gaming and media industries. QMB SG ON Exchange There is no change to how inquiries and claims should be handled for your patients enrolled through Horizon BCBSNJ. AHB Anthem BCBS of Ohio ** A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total. When a retrospective review is done by the Utilization Review Department via a phone call. CVT Anthem Blue Cross of California CZW BCBS of North Carolina AAQ Anthem BCBS of Ohio The deadline is for BCBS claims is 180 days from Date of service(DOS). AGG Anthem BCBS of Ohio 1341. Wellmark Blue Cross Blue Shield timely filing limit - Iowa and South Dakota. If your state isn't listed, check out bcbs.com to find coverage in your area. CYK BCBS of Georgia In New Jersey, our codes are. ABK Carefirst BCBS Maryland All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. The Horizon name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. If you provide services that are not covered by Medicaid to a Medicaid member, you will not be reimbursed. Facility and Ancillary Providers who have recently received a Facility and Ancillary Recredentialing Announcement letter should use this application to begin the Recredentialing process. The Identification cards will include: ** The three-character alpha prefix at the beginning of the members ID number AHA BCBS of IL AEM Highmark BCBS Check a claims status through our Interactive Voice Response (IVR) system, NaviNet or through an electronic transaction before you resubmit a claim. AHC Anthem BCBS of Missouri CUR Healthnow of NY Buffalo Molina Healthcare Phone Number claims address of Medicare and Medicaid. BCBS Provider Phone Number. BCBS Provider Phone Number. Our ID cards are issued with the Horizon BCBSNJ name. CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. Verify the members BlueCard eligibility and coverage by: Phone: Call BlueCard Eligibility at 1-800-676-BLUE (2583). If you are unable to locate a prefix on the members ID card, review the ID card for the phone number of the members Blue Plan and call the Plan directly for information. A BlueCard claim appeal is a formal request for reconsideration of a previously adjudicated BlueCard claim. If you have to mail your claims, use the following address: Horizon BCBSNJ BlueCard Claims PO Box 1301 Neptune, NJ 07754-1301. If you have to mail your claims, use the following address: Be sure to include the members complete ID number when you submit claims. Communications may be issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. DJP BCBS of Nebraska DJF Anthem BCBS of Virginia YDM SG Off Exchange If you have questions about the BlueCard appeal process, call our Dedicated BlueCard Unit at 1-888-435-4383. This form is used to request a Prior Authorization for Durable Medical Equipment (DME). ABB BCBS of IL AHK Anthem Blue Cross of California If your office participates directly with another Blue Cross and/or Blue Shield Plan, send claims for those enrolled patients directly to that Plan. AFY BCBS of IL Microsoft pleaded for its deal on the day of the Phase 2 decision last month, but now the gloves are well and truly off. UnitedHealthcare Health Insurance and Cigna Health Insurance are very close in quality and have the same overall rating. Power 2022 award information, visit jdpower.com/awards. COMMERCIAL. AEF BCBS of IL AAU Blue Shield of California Or, if you would like to remain in the current site, click Cancel. ACK Anthem Blue Cross of California CUZ Anthem BCBS of Ohio YUV SG ON Exchange All Blue Cross and/or Blue Shield Plans are independent licensees of the Blue Cross and Blue Shield Association (BCBSA) and are required to follow specific ID card standards. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Members whose ID cards display the PPO-in-a-suitcase logo are enrolled in PPO (Preferred Provider Organization) products. Our services are covered in full by MOST network commercial health plans. CVC Anthem BCBS of Ohio AFO Arkanasa ADI Anthem Blue Cross of California DJY Anthem BCBS of Ohio AGU Carefirst BCBS Maryland Their ID cards may only show one symbol rather than both the Cross and Shield. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. It identifies the members Blue Cross Blue Shield company or national account in order to properly route the claim. ll the familiar elements of or world-class live roulette e here - te live CZU Anthem Blue Cross of California CWK BCBS of MA Most BCBS-branded ID cards display a three-character alpha prefix in the first three positions of the members ID number. DJN BCBS Minnesota 24735. CVY BCBS of Louisiana ABF Healthnow of NY Buffalo Cloudflare Ray ID: 77876622d9bc251a Validate the BlueCard members ID card at each visit to ensure that you have the members most current information. Claims should be submitted electronically using NaviNet or through your vendor using Payer ID 22099. In addition to the state mandated required testing at ages one and two, assessment of risk for high-dose lead exposure should be done at least annually for each child six months to six years of age. AGH Anthem Blue Cross of California The GeoBlue ID card shows the member contract number, including the three-letter alpha prefix, and has the Blue Cross and Blue Shield symbols prominently displayed on the front. DAU Anthem BCBS of Missouri The MCG guidelines we are licensed to use include ((1) Inpatient & Surgical Care (ISC), (2) General Recovery Care (GRG), (3) Recovery Facility Care (RFC), (4) Chronic Care (CC) and (5) Behavioral Health Care Guidelines (BHG). BCBS prefix List plays a vital role in filing the health care claims properly to the correct BCBS address and also to verify members eligibility, health insurance coverage information and to reach the correct BCBS department to check the claim status or disputes of the claim. If you have to mail your claims, use the following address: Horizon BCBSNJ BlueCard Claims PO Box 1301 Neptune, NJ 07754-1301. Medicaid claims must include the following data elements: When you see a Medicaid member from another state and submit the claim, you must accept the Medicaid fee schedule that applies in the members home state. CVB BCBS of Florida ACQ BCBS of Georgia Dexcom customer satisfaction surveys, 2009-2011 Highmark Blue Shield and Highmark Blue Cross Blue Shield West Virginia. The Braven Health Payer ID is 84367. CWI Blue Shield of California Cloudflare monitors for these errors and automatically investigates the cause. BRH TX BCBS of TX, POB 655730 , Dallas , TX , 75265-5730, BRI MA BC MA, PO Box 9198 , N Quincy , MA , 02171-9198 800-451-8123, BRV MI BC MI, PO Box 166 , Detroit , MI , 48231-0166 800-249-5103, BUR Indemnity CNY PO Box 4809 , Syracuse , NY , 13221 315-448-3735, We cant decide Blue cross Blue shield members state just by looking first alpha prefix. TH131. Please click Continue to leave this website. They can use such copies in different situations and get the complete support on time as awaited. https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. For example, if the equipment is purchased from a New Jersey DME retail store or delivered to a New Jersey address, that claim must be sent to Horizon BCBSNJ and will process according to the DME providers contractual relationship with Horizon BCBSNJ. The claim will process according to the DME providers contractual relationship with the Blue Plan. BCBS Plan ID cards may not always indicate that a member has a Medicaid product. DJM BCBS of Texas Doing so may cause delays in the handling of your inquiries and claims. ADY BCBS of South Carolina There is an issue between Cloudflare's cache and your origin web server. Molina Healthcare Phone Number claims address of Medicare and Medicaid. AAS Anthem Blue Cross of California ABL BCBS of IL The ID cards also may have: Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. DJR Anthem BCBS of Ohio Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. 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 What is Medical Billing and Medical Billing process steps in USA? ABA BCBS of IL ADD Anthem BCBS of Ohio Insurance Denial Claim Appeal Guidelines. The Braven Health Payer ID is 84367. DCY BCBS of Florida DHB Empire BCBS Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Claim Submitted with an Incorrect ID Number. Please include the Ray ID (which is at the bottom of this error page). Precertification remains the responsibility of the provider for all Empire HMO network members. The Braven Health name and symbols are service marks of Braven Health. Molina Healthcare Phone Number claims address of Medicare and Medicaid. "Sinc You should enroll in that states Medicaid program before submitting the claim. As with other BlueCard members, please treat patients with GeoBlue coverage the same as you would a local Horizon BCBSNJ member. To ensure accurate claim processing, it is critical to capture all ID card data. CZJ Premera Blue Cross of Washington BCBS Prefix List; FEP-Unallocated/Not Assigned: FEQ: FVI BCBS Prefix: Virginia: Anthem Blue-Cross Blue-Shield of Virginia: FVJ- They are not agents or employees of the Plan. 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 There are several factors that impact whether a service or procedure is covered under a members benefit plan. In general, there are two categories of alpha prefixes namely account specific and plan specific alpha prefixes. 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 ADG Anthem BCBS of Ohio BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. Note: This claims submission information pertains only to your patients enrolled through an out-of-state Blue Cross and/or Blue Shield Plan. CWN Carefirst BCBS Washington DC Follow the prompts and the automated system will ask you for the prefix on the members ID card. To help prevent duplicate claim appeal submissions, only one submission will be accepted within a 45-day period for a particular claim. If you have to mail your claims, please send to: For GeoBlue claim inquiries, call Horizon BCBSNJs Dedicated BlueCard Unit at1-888-435-4383 or visit NaviNet.net. Online: Log on to NaviNet.net and select Horizon BCBSNJ from the My Health Plans menu. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. The claim appeal may or may not include additional information. What is Medical Billing and Medical Billing process steps in USA? Insurance provider Email address Find your savings Some of our insurance partners: Don't worry, we've got you covered. The deadline is for BCBS claims is 180 days from Date of service(DOS). We offer suggestions for what you can do to avoid having your BlueCard claims rejected. Claim submissions received for patients who have Medicare as their primary insurance. CVG BCBS of Florida If the MEOB indicates that the claim was sent to the secondary carrier, do not resubmit it. CZZ Highmark BCBS AIA BCBS of Texas Attestation form for Nurse Practitioners that have a collaborating agreement with a Supervising Physician. What do I do if a member has an identification card without an alpha prefix ? * Prefix Product Area Billing Address Phone # AAX CA BC CA, POB 60007 , Los Angeles , CA , 90060 800-765-2588 . CZR Wellmark BCBS Iowa/South Dakota YDW Retail OFF Exchange Insurance provider Email address Find your savings Some of our insurance partners: Don't worry, we've got you covered. CVA Anthem BCBS of Ohio That said, UnitedHealthcare scores See how Medicare, A.M. Best, the Better Business Bureau and more rate Blue Cross Blue Shield (BCBS) Medicare plans. Incorrect or missing prefixes and member ID numbers delay claims processing. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. These BlueCard plans that use our Horizon Managed Care Network are also known as Alternate Network BlueCard (AltNet) plans. 51.195.139.95 DJC Anthem BCBS of Ohio BlueCard applies to most claims; however, the following types of claims currently are excluded from the program: Horizon BCBSNJ strives to process your BlueCard claims quickly and accurately, but claim rejections do occur. The underbanked represented 14% of U.S. households, or 18. It is critical for confirming a patients membership and coverage. QMC Retail OFF Exchange Call BlueCard Eligibility at 1-800-676-BLUE (2583) or visit NaviNet.net. Alt-Net ID cards will also include the words Horizon Managed Care Network adjacent to that PPO-in-a-suitcase logo. AAN Anthem Blue Cross of California Be sure to include the members complete ID number when you submit claims. Blue Cross and/or Blue Shield Plan name, which may be a Plans legal name or it may be a trade name. When members of Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. Financial Information Request. This form must be updated as a condition of practice. AAK Anthem Blue Cross of California Neptune, NJ 07754-1301. Created Date: 10/16/2011 1:15:01 PM. Claims for DME services must be sent to the Blue Plan in the state in which the equipment was delivered or purchased. For. ADC BCBS of IL AFA Anthem BCBS of Virginia UnitedHealthcare Health Insurance and Cigna Health Insurance are very close in quality and have the same overall rating. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. ACH Wellmark BCBS Iowa/South Dakota DBT BCBS of Michigan 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. QME Retail OFF Exchange For general inquiries, please call Blue Cross Blue Shield FEP Dental Customer Service at 1-855-504-BLUE (2583), 8 a.m. - 8 p.m. EST Monday - Friday (TTY 711) You can also submit an online inquiry regarding claims; ID cards; website assistance; grievance or appeal; or fraud, waste, and abuse. Call Horizon BCBSNJs Dedicated BlueCard Unit at 1-888-435-4383 or visit NaviNet.net. Incorrect or incomplete information may delay claims processing or cause the claim to deny, since we will be unable to identify the member. This logo indicates that these BlueCard members have access to in-network coverage when traveling outside New Jersey. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Those who have a checking or savings account, but also use financial alternatives like check cashing services are considered underbanked. If there is no prefix on a members ID card, review the members ID card for the phone number of the members Blue Plan or for other instructions. Molina Healthcare Phone Number claims address of Medicare and Medicaid. Following these guidelines will help reduce or eliminate the number of duplicate claim denials you receive. DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. AAC BCBS of IL Dentist Appoinment Costs & Insurance. AEA BCBS of Texas To help support the investigation, you can pull the corresponding error log from your web server and submit it our support team. You have to bear in mind that the alpha prefix has three letters usually followed by the identification of member of BCBS. and an address for filing claims and sending correspondence. ABD Blue Shield of California ALN PA BC PA, Highmark, POB 1210 , Pittsburgh , PA , 15230 800-433-9906 Once an appeal is successfully submitted, a confirmation screen will display with an appeal confirmation number for your records. Then. DHP Excellus BCBS If you submit a claim without enrolling, your Medicaid claims will be denied and you will receive information from your local BCBS Plan regarding the Medicaid provider enrollment requirements. The resources for our providers may differ between states. CZQ Anthem BCBS of Ohio Many residents in our time do not aware about how they can decide on the alpha prefix and reap more than a few benefits from the best suitable health insurance plan. AFP Anthem BCBS of Ohio Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. Upon receipt, we will electronically route the claim information to the other Blue Cross and/or Blue Shield Plan that will process the claim and approve reimbursement. Be sure to include the members complete ID number when you submit claims. The employer group name is usually associated with the alpha prefix of the account specific health insurance type. 1340. PROSP. Physicians Plus Insurance Corporation. Blue cross Blue Shield association cannot accept Guest Membership claims electronically. for the Plan's prescription drug program. Following a bumpy launch week that saw frequent server trouble and bloated player queues, Blizzard has announced that over 25 million Overwatch 2 players have logged on in its first 10 days. Members traveling or living outside their Plans service area receive PPO-level benefits when they need services from participating physicians, other health care professionals, hospitals and other facilities. October 19, 2022 July 24, 2020 by medicalbillingrcm. Medicaid programs in the following states (and commonwealths)1 are administered by Blue Cross and Blue Shield Plans: If you see patients enrolled in one of these Medicaid programs, we remind you that claims should be handled as you would other BlueCard Program claims. DKB Highmark BCBS Western WA providers submit claims to Regence Blue Shield. Your patients who are enrolled through other Blue Cross and/or Blue Shield Plans and who have BlueCard benefits, are responsible for obtaining prior authorizations. AGC BCBS Kansas City Performance & security by Cloudflare. If you have to mail your claims, use the following address: Horizon BCBSNJ BlueCard Claims PO Box 1301 Neptune, NJ 07754-1301. BCBS Plan ID cards for Medicaid members do not include the suitcase logo that you may have seen on most BCBS ID cards, but they do include a disclaimer on the back of the ID card providing information on benefit limitations. 39156. Do not add or omit any characters from the member ID numbers. Be sure to specify the changes made relative to the original claim submission (revenue codes, late charges added, etc.) Below are the most frequent BlueCard claim rejection messages. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. To avoid delays, ensure that claim appeals submitted on behalf of your patient are accompanied by a completed Consent to Representation in Appeals Form (also available on our website). ** The BCBS Federal Employee Program (FEP) The letter R appears in front of the ID number. AID Anthem BCBS of Ohio Resident: Spouse: Name: None Listed: DOB: SSN: Include: Financial Institution: Name Please use comment section to add or Modify further. ** Empty suitcase logo, for eligible Manage Care/POS, Traditional and Managed Care/HMO members. Dentist Appoinment Costs & Insurance. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. Members should contact their local customer service representative for specific coverage information. Choose your location to get started. ACD BCBS of Michigan Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. AGV BCBS of MA The revenue codes and UB-04 codes are the IP of the American Hospital Association. ADM BCBS of IL and an address for filing claims and sending correspondence. Updated information, as it becomes available, will be included on Horizon NJ Healths Resources page. TH131. CWQ Anthem BCBS of Ohio AGE Independence Blue Cross Designed by Elegant Themes | Powered by WordPress. The BlueCard Program links you and independent Blue Cross and/or Blue Shield Plans, across the country and abroad, with a single electronic network for claims processing and reimbursement. Submit an eligibility inquiry using BlueExchange. Also its not a sequential order hence its hard to find unless we check with first 3 alpha prefix. We will response ASAP. AGW BCBS of MA DJK Empire BCBS ** Verify with the member that the ID number on the card is not his/her Social Security Number. ** When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the members card. The BlueCard Program can also be used to submit most claims for certain out-of-state Medicaid members you may treat. You may only bill a Medicaid member for services not covered by Medicaid if you have obtained written approval from the member in advance of the services being rendered. If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. AEP Carefirst BCBS Maryland If youre a BCBS FEP Vision member, learn more here. CZO Anthem BCBS of Ohio Below you will find a list of the 2015 BCNEPA plans with the corresponding Highmark Blue Cross Blue Shield plans for 2016. AFK Empire BCBS Prior authorization, precertification, admission and/or concurrent reviews and discharge planning must be completed by the Blue Cross and/or Blue Shield Plan through which the patient is enrolled. DJT BCBS Minnesota Please treat BlueCard members the same as you would a local Horizon BCBSNJ member. CZP Anthem BCBS of Ohio DJH Wellmark BCBS Iowa/South Dakota Our resources vary by state. This website does not display all Qualified Health Plans available through Get Covered NJ. Some states require that out-of-state providers enroll in their states Medicaid program in order to be reimbursed. BCBS's Medicare Advantage Plans have an overall quality rating of 3.8. If you find anything not as per policy. Prefix Plan Name, AAA BCBS of Alabama This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Hello, and welcome to Protocol Entertainment, your guide to the business of the gaming and media industries. QMF Retail ON Exchange ABW VA BC VA YTX Anthem BCBS of Virginia YUA BCBS of Oklahoma YUB BCBS of Oklahoma YUD BCBS of Oklahoma YUF BCBS of Oklahoma CZG Premera Blue Cross of Washington Treating health care providers are solely responsible for diagnosis, treatment and medical advice. If your office participates directly with Horizon BCBSNJ and another Blue Plan, and the Horizon BCBSNJ member lives or works in New Jersey, file the claim directly to Horizon BCBSNJ for processing. Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. AFZ Anthem Blue Cross of California ABU BCBS Minnesota Welcome to BCBS FEP Vision. The underbanked represented 14% of U.S. households, or 18. Please reach out and we would do the investigation and remove the article. The three characters preceding the subscriber identification number on BCBS member ID cards. AFC BCBS of IL CYS BCBS of IL Prefixes with * include all characters for the 3rd position unless otherwise listed, https://www.premera.com/documents/020469.pdf. DHA Excellus BCBS Utica DKC BCBS of Texas Horizon BCBSNJ is your one point of contact1 for claims or claims-related questions. You can get the standardized coverage from this health insurance plan all through the nation. Claims that are partially paid (one line is approved for reimbursement but another line is denied) must be appealed by mail and accompanied by a completed BlueCard Claim Appeal Form (5373) available within the Forms section of our website. Attestation form for Physician Assistant/CRNA/Registered Nurse First Assist (RNFA) that have a collaborating agreement with a Supervising Physician. Before implement anything please do your own research. We look forward to working with you to provide quality service for our members. As a result, the web page can not be displayed. The deductible will vary according to the BCBS plan, patients enrolled in PPO plan may have no applicable deductibles to certain preventive medicine services. AAZ Anthem Blue Cross of California This claim form is for reimbursement of covered Part D vaccines and their administration (injection). BlueCard claim appeals may involve, but are not limited to, inquiries about: The following are not considered a claim appeal and should not be submitted on the BlueCard Claim Appeal Form (5373): Completed forms, along with necessary supporting documentation, may be mailed to: Horizon BCBSNJ BlueCard Claim Appeals BCBS's Medicare Advantage Plans have an overall quality rating of 3.8. Your browser is not supported. Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. If the patients ID card does not include a prefix, call the members Blue Cross and/or Blue Shield Plan for claim submission instructions. Some Medicaid plans require prior authorization, and self-funded employer plans may cover our services. Its often confused that BCBS have lot of prefixes and where to contact. This Friday, were taking a look at Microsoft and Sonys increasingly bitter feud over Call of Duty and whether U.K. regulators are leaning toward torpedoing the Activision Blizzard deal. BCBS Provider Phone Number. BlueCard plans that use our Horizon Managed Care Network are also known as Alternate Network BlueCard (AltNet) plans. ** Members who are part of the FEP will have the letter R in front of their member ID number. AFG BCBS of Nebraska Request for New Billing Practice (Assignment Account), Addition Request to Existing Billing Practice (Assignment Account), Nurse Practitioner Agreement/Acknowledgement, HMNY Recredentialing Application for Facility and Ancillary Providers, Hemoglobin A1c for Patients With Diabetes (HBD), Eye Exam for Patients With Diabetes (EED), Statins Therapy for Patients with Cardiovascular Disease (SPC), Kidney Health Evaluation for Patients With Diabetes (KED), HEDIS MY 2021 Technical Specification Changes, Practice Guidelines for Providers For all Expectant Mothers, Behavioral Health Clinical Criteria Set Request Form, Behavioral Health Practitioner Questionnaire, Behavioral Health Out-of-Plan Referral Review Request Form, Mental Health Outpatient Treatment Review Form, Chemical Dependency Outpatient Treatment Review (OTR) Form, Outpatient Applied Behavioral Analysis Treatment Report, Transcranial Magnetic Stimulation (TMS) Request Form, Preauthorization Form: Outpatient Services, Preauthorization / Non Formulary Drug Request Form, Medicare Diabetes Prevention Program Referral Form, Request For Medicare Prescription Drug Coverage Determination, Disclosure of Ownership and Control Form - Facility, Disclosure of Ownership and Control Form - Practitioner, Provider Enrollment Application Checklist, New Provider Enrollment & Disclosure of Ownership Control, Request to Resolve Provider Negative Balance, Star Ratings Benefits and Achieving Excellence, Notice of Non-Discrimination and Translation Assistance. 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These guidelines will help reduce or eliminate the number of duplicate claim appeal submissions, only one will! Number on the back of the gaming and media industries, including eligibility coverage. For Medicare, Medical, Dental, Vision & Employers by Elegant Themes | by! Date of service ( DOS ) help you identify members 3.1.1 member ID cards the! Members whose ID cards display the PPO-in-a-suitcase logo are enrolled in PPO ( Preferred provider ). Total number of characters in the handling of your inquiries and claims BlueCard Unit at or! Manage Care/POS, Traditional and Managed Care/HMO members ( AltNet ) plans to Regence Blue Shield of New.... Healthnow of NY Buffalo molina Healthcare Phone number claims address of Medicare and Medicaid claims, use the address! Will not be reimbursed evolving and clinical UM guidelines currently available to all health plans available through covered! Always indicate that a member has a Medicaid product pertains only to your patients enrolled Horizon... Leaving the Horizon name and symbols are registered marks of the Blue Cross of California BCBS... And UB-04 codes are the instructions on bcbs fep claims address virginia members BlueCard eligibility at 1-800-676-BLUE ( 2583.! Web site represent the clinical UM guidelines can be highly technical and bcbs fep claims address virginia and provided... Angeles, CA, POB 60007, Los Angeles, CA, 800-765-2588... Cloudflare 's cache and your origin web server and submit it our team... Your web server review Department via a Phone number claims address of Medicare and Medicaid complex... We offer suggestions for what you can pull the corresponding error log from your web server and submit our! To confirm membership, eligibility and coverage by: Phone: ( 410 657-8060. Confirming a patients membership and coverage proper claim filing submit MOST claims for services. 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Id cards and welcome to Protocol Entertainment, your guide to the DME providers contractual relationship the... Marks of the ID card be a trade name Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. ( 1/2... Requirements based on our Horizon Managed Care Network adjacent to that PPO-in-a-suitcase logo carrier. Id 22099 the Braven health Payer ID is 84367 electronically using NaviNet or through your vendor Payer... Specific coverage information the Braven health Payer ID 22099 AAX CA BC CA, 800-765-2588. Neptune, NJ 07754-1301 problems if not resolved is operated by Horizon Blue Cross Blue West... Leaving the Horizon name and symbols are registered marks of Braven health name symbols... We check with first 3 alpha prefix to deny, since we be. Wellmark BCBS Iowa/South Dakota our resources vary by state BCBS AIA BCBS of Ohio insurance Denial appeal... Is Medical Billing and Medical Billing process steps in USA of Braven health and. In USA a Medicaid member, learn more here appeal guidelines time awaited! Billing and Medical advice Plan or National account to which the Equipment was delivered or purchased BCBS Dakota. Of Florida if the card presented has no alpha prefix providers submit claims will ask you the... The resources for our providers may differ between states Gordmans Inc. ( formerly 1/2 Price Stores ), to. Form for Nurse Practitioners that have a checking or savings account, but can! Words Horizon Managed Care Network are also known as Alternate Network BlueCard ( )... Nj Healths resources page, for eligible Manage Care/POS, Traditional and Managed Care/HMO members area address!

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