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All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. To ensure accurate claim processing, it is critical to capture all ID card data. CYP BCBS of IL Your member ID card is your key to using your medical plan benefits. The earlier you submit claims, the earlier we process them. AFA Anthem BCBS of Virginia Mail the overpayment amount to our finance department (address on check) along with a completed Refund Request form, or. Remember to include the leading three-character prefix and enter it in the appropriate field on the claim form. Tennessee. AEA BCBS of Texas Related . QAB. For more information, view our privacy policy. Please review the terms of use and privacy policies of the new site you will be visiting. Deutsch | If member does not return the call, claims will be denied until information is received. Heres everything you need to know about it. Do not make up alpha prefixes or assume that the members ID number is the Social Security Number. Professional Services are performed by a doctor or other healthcare professional. ADJ Anthem BCBS of Missouri For more information, view our privacy policy. 553 46 Box 22999 Rochester, NY 14692 *New York *The Buffalo office handles the receipt of claims and correspondence for BS You can also use the Office of Financial Management MyPortal to update your address. QMF Retail ON Exchange AEO MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, AFM PA BC PA, 5th Ave Pl Ste 2012L , Pittsburgh , PA , 15222 800-489-4484 AGF Anthem BCBS of Ohio Need help with a claim? We also apply the following Prompt Pay standards set by the State of Alaska to our claims adjudication process in order to: Oregon contracted and non-contracted To cancel or waive your coverage, visit the PEBB Program website using these links: Uniform Medical Plan (UMP) is a self-insured Preferred Provider Organization (PPO) medical plan offered through the Washington State Health Care Authority. AIH Anthem Blue Cross of California ABJ BCBS Minnesota Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. CZK Anthem BCBS of Virginia Regence BlueShield Attn: UMP ClaimsP.O. Our medical staff reviewed this claim and determined that this service isn't covered by the plan. 1-800-962-2731. Box 25 Enter the applicable tax ID number. CVT Anthem Blue Cross of California To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. In these cases, please don't return the check to us. 1-866-977-7378. See our FAQs for more claim information and contacts. ABA BCBS of IL (BlueCard will request refunds regardless of the dollar amount.) Company Description: Regence BlueCross BlueShield of Oregon provides health insurance products and other managed care services to some 750,000 members in Oregon and Washington's Clark County. The revenue codes and UB-04 codes are the IP of the American Hospital Association. 4. CWH Anthem Blue Cross of California Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Provider: send us the member's medical records for this claim. Coding toolkit View our clinical edits and model claims editing. | DJQ Anthem Blue Cross of California the claims for which interest payments have been applied during that period. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. Health . startxref Premera Blue Cross & The Regence Group Common Alpha Plan Prefixes Last updated: 09/01/2016 Premera Blue Cross & Premera Blue Cross/NASCO Prefixes Western WA providers submit claims to Regence Blue Shield. You can make a complaint verbally to Customer Service or in writing to Customer Service Correspondence. If the member does not return the IQ within the specified timeframe, we'll deny all related claim(s). BCBS Provider Phone Number. You can submit a complaint about one of our actions (verbally or in writing) to one of our employees. Other specialized services (home hospice, organ/tissue transplants, and clinical trials). This alpha prefix of BCBS plays the major role behind the proper way to claim the health insurance plan without delay and difficulty. 1 (877) 878-2273 Phoenix, AZ 85072, Retail Pharmacy Program ** Blank, or empty suitcase logo. CZB Wellmark BCBS Iowa/South Dakota AGC BCBS Kansas City Box 260070 Pembroke Pines, FL 33026 . EMPIRE BCBS Decides the pre certification requirements based on the prefix id. See the following pages for an explanation of the EOP fields and a description of codes and messages. Service not a benefit of subscriber's contract, Investigational or experimental procedure. Find Contact Information. 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). Policy #s: Regular 10017241-0001, Transit 10017241-0004, Sheriff 10017241-0016 . Your software vendor can help you set up your computer to accommodate Premera's billing requirements. BCBS Company. Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. Alaska contracted and non-contracted (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) DJN BCBS Minnesota YDV SG ON Exchange Instead, deposit the check, circle the claim in question on the Explanation of Payment (EOP) and include a short explanation as to why there was an overpayment. AFS Blue Shield of California We are unable to quote a benefit by a diagnosis or procedurecode. Does not determine the reimbursement dollar amount for any particular service (reimbursement is specific to the provider applicable fee schedule). CVZ Horizon BCBS of New Jersey ABB BCBS of IL 0000018816 00000 n 0000004829 00000 n 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 | All our content are education purpose only. Use the following codes: In the Original.Ref.Co segment of box 22 enter the original claim number. The employer group name is usually associated with the alpha prefix of the account specific health insurance type. DJP BCBS of Nebraska To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. Colorado. complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. ABV Anthem BCBS of Ohio 10700 Northup Way, Suite 100 AAN Anthem Blue Cross of California . Interest less than ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network Payment policy: You can find our payment policies on our website in the Library, under Reference Info. 0000055309 00000 n REGENCE BLUE CROSS BLUE SHIELD OF OREGON - 12 Reviews - 100 SW Market Str, Portland, Oregon - Health & Medical - Phone Number - Yelp Regence Blue Cross Blue Shield of Oregon 12 reviews Unclaimed Health & Medical Write a review Add photo Photos & videos Add photo You Might Also Consider Sponsored TLC Laser Eye Centers 29 AEF BCBS of IL Contact. CMS also uses RVUs to allocate dollar values to each CPT or HCPCS code. DJM BCBS of Texas This procedure is considered cosmetic. AHJ Independence Blue Cross PO Box 52080 AGL Premera Blue Cross of Washington The three characters preceding the subscriber identification number on BCBS member ID cards. If we processed the original claim incorrectly, you do not need to rebill. %PDF-1.4 % claims status, . | QMG SG OFF Exchange. We use an automated processing system to adjudicate claims. 0000018992 00000 n 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. Check out the changes and updates to our plan in 2023. CVM Anthem BCBS of Ohio 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. ), claims will be processed accordingly and under the terms of our subscriber's contract. Please use comment section to add or Modify further. This is worthwhile to avoid selecting the alpha prefix randomly. People who include both alpha prefix as well as alpha numeric characters precede the alpha prefix in every claim and correspondence submitted to BCBS can get the desired assistance almost immediately. Complaints received beyond the 365-day timeframe will not be reviewed and the appeals rights pertaining to the issue will be exhausted. 0000008643 00000 n LAA. Type forms in black ink (handwritten forms cannot be read by OCR equipment). ), Covered under the provisions of motor vehicle medical policy, personal injury protection (PIP), medical payments (Medpay), Uninsured (UIM) and/or underinsured (UM) motorist or other similar coverage (e.g., homeowners, commercial medical premises), Checks for eligibility of the member listed on the claim, Compares the services provided on the claim to the benefits in the subscribers contract, Applies industry standard claim edits and applicable payment policy criteria, Applies to professional and facility claims. You have 365 calendar days to submit a complaint following the action that prompted the complaint. Get immediate member information by phone or fax . 1-800-423-1973. 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. Box 105557. Note that some processing systems may have a limitation regarding the number of characters recognized. For complete plan details, seeBenefits Summaries. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. ADY BCBS of South Carolina When we process a claim, we coordinate benefits if the member has other primary coverage from another carrier, our health plan, service plan, or government third-party payer. AFC BCBS of IL AFO Arkanasa Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). CVG BCBS of Florida If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. Once the claim is found, you can click on original EOP view to pull up this information. 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. Regence BlueShield - FEP PO Box 857 Lewiston, ID 83501. We can't process this claim because we haven't received your response to our request for information. We are unable to quote a benefit by a code. Before discussing member claim information, the Customer Service representative must verify the identity of the caller. AGW BCBS of MA 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. 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 VOG NY MA PPO MediBlue PPO Plus 1-866-395-5175 H3342, Premera Blue Cross & The Regence Group Common Alpha Plan Prefixes Last updated: 09/01/2016, Premera Blue Cross & Premera Blue Cross/NASCO Prefixes. 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: 0 When Calypso identifies an overpayment, they mail an Overpayment Notification letter with a request for the overpaid amount. CWK BCBS of MA Prefixes with * include all characters for the 3rd position unless otherwise . ABY Carefirst BCBS Maryland Premera Blue Cross Blue Shield of Alaska FEP PO Box 33932 Seattle, WA 98133-0932, Phone:800-562-1011 For more information about RBRVS methodology visit the CMS website. If you are not registered, please click on the Not Registered link to set up your account. Deutsch | CZV BCBS of Alabama 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. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. Tagalog | any missing required substantiating documentation or particular circumstances requiring special treatment. ** Do not add/delete characters or numbers within the member ID. We will send the member an IQ if the claim(s) is potentially accident-related. CZF BCBS of Rhode Island You can print and assist the member in completing the form, but it's important to review the instructions included with the form because the patient must complete the form and then sign it. Blue Advantage Administrators of Plan to submit test claims. Correspondence. 0000011774 00000 n CVJ BCBS of Florida There is no charge to healthcare providers who submit electronic claims directly to us. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Box 52890Bellevue WA 98015 or fax at 1-866-458-5488. Blue-Cross Blue-Shield of Illinois. 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 Here are common reasons why claims suspend or reject: Contact Customer Service with questions regarding claims processing or send a copy of the voucher highlighting the claim in question and the inquiry reason. 4. AES BCBS of Alabama 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. Special Message: Coming soon, you will be able to dispute (appeal) a claim on Availity from the claim status result page. When the conversion factor is multiplied by the total RVUs, it will yield the reimbursement rate for the specific service (or code). (Field not populated for CMS-1500 claims. However, fax submission is allowed at the ollowing fax numbers: 866-365-5504 or 303-764- 7123 for BCBS OF CA AND BCBS OF CO. 0000056226 00000 n BCBS Provider Phone Number. AHD BCBS of South Carolina In some contracts, we use a RBRVS methodology, developed by CMS, to calculate its fee-for-service fee schedule. A Statement of Overpayment Recoveries (SORA) is included with an Explanation of Payment (EOP) when we've processed an overpayment recovery activity within a payment cycle. CYN Highmark BCBS Please follow Bill all original lines-not including all of the original lines will cause the claim to be rejected. AFM BCBS Minnesota | YDM SG Off Exchange 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. APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 AHO BCBS of Tennessee If member returns the call and the information is obtained, claims will be processed. CUU BCBS of Texas Regence BlueShieldAttn: UMP ClaimsP.O. The maximum limit has been met for this benefit. All of our contracts exclude coverage for care covered under the Workers' Compensation Act. 0000013357 00000 n Appeals rights will be exhausted if not received within the required timeframe. We can't process this claim until the incident questionnaire we sent the member is fully completed, signed and returned. The Identification cards will include: ** The three-character alpha prefix at the beginning of the members ID number ACQ BCBS of Georgia AHA BCBS of IL 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: Calypso, our affiliate, processes refunds and overpayment requests. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. | Diabetes. 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. Claim edits in place will identify those services previously billed and bundle ALL services on to a single We're ready. You can use Availity to submit and check the status of all your claims and much more. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. That way, we can verify your account and start helping you as quickly as possible. Eligibility, enrollment, and address/name changes. AEJ Horizon BCBS of New Jersey Availity. DHA Excellus BCBS Utica Stay up to date on what's happening from Bonners Ferry to Boise. This claim is a duplicate of a previously submitted claim for this member. you will need to contact Regence to update your account to ensure your claim processes correctly and timely. Below you will find a list of the 2015 BCNEPA plans with the corresponding Highmark Blue Cross Blue Shield plans for 2016. If you are outside the U.S. and need to find a local provider, make an appointment or be hospitalized, call Blue Cross Blue Shield Global Core at 1-800-810-2583 or call collect at 1-804-673-1177, 24 hours a day, 7 days a week. Payment of this claim depended on our review of information from the provider. Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. 0000010231 00000 n 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. 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 Email: Medicare/Medicaid: PRmedicaremedicaid@bcidaho.com. YDW Retail OFF Exchange We can process the claim after we receive that information. 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. Paper Claim Form . ADI Anthem Blue Cross of California STATE MAIL TO MAILING ADDRESS CITY, STATE ZIP Alabama Blue Cross and Blue Shield of Alabama 450 Riverside Parkway E Birmingham, AL 35298 . AHI BCBS of Rhode Island 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. AHQ Anthem BCBS of Ohio If the information received indicates an on-the-job illness or injury, both the member and physician/provider will receive a denial that states the Premera contract excludes work-related conditions. 401 Fifth Ave. We recommend that you make copies of everything that is submitted for your personal records. View your credentialing status in Payer Spaces on Availity Essentials. ACK Anthem Blue Cross of California YUV SG ON Exchange If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Italiano | Enter a ZIP code in that box. Payments are issued under a separate voucher and mailed to the address on the original claim. CUW Anthem Blue Cross of California It doesn't replace your tax ID number (TIN) or Drug Enforcement Administration (DEA) number. note: Exclusions to paying interest may apply based on line of business. We notify you in writing if the request for mediation is not timely. ADD Anthem BCBS of Ohio Regence Uniform Medical Plan Vision Claim Form - An ERISA Section 502 (a) prepare can be reported in many different methods. Hours: 8 a.m. 4:30 p.m. weekdays, Find certified small business contractors and suppliers. You can learn more about credentialing by visiting the provider section of our website. PO Box 3876. 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. ACD BCBS of Michigan AGE Independence Blue Cross Included with the interest voucher is a summary report detailing Membership Address. DKB Highmark BCBS FAQs & Resources What type of EDI transactions does RGA accept? 0000009519 00000 n Our electronic claims process electronically separates and routes only valid claims for processing. LAB. Availity supports the exchange of electronic remittance advice (ERA) files for Regence payers in the ASC X12 835 format. ** A local network identifier, (for example, BlueMark) You can verify your address by calling PEBB Customer Service at We will notify you once your application has been approved or if additional information is needed. Box 3004 Naperville, IL 60566-9747. Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. AFP Anthem BCBS of Ohio New York, New York 10008-3876. If you are unable to submit claims electronically, you can submit paper claims on CMS-1500 or UB-04 forms. When submitting claims, transfer the members identification (ID) number exactly as printed on the ID card. The plan mailing addresses are available on our website under Contact Us. Postal Prescription Services Online: Your PPS account Phone: 1 (800) 552-6694 TRS: 711 Fax (for providers only): 1 (800) 723-9023 If your organization is contracted with Premera, most practitioners must be credentialed, with the exception of hospital-based practitioners. Coordination of Benefits (COB) is a provision included in both member and physician and provider contracts. Before implement anything please do your own research. 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. | Your office staff can then post this remittance manually or electronically (if your software has electronic posting capability). View the toolkit Claims submission CVA Anthem BCBS of Ohio Completion of the credentialing process takes 30-60 days. Pension & Retirement. CUR Healthnow of NY Buffalo 0000007198 00000 n If it is, call the BlueCard Eligibility line 800-676-BLUE (2583) to verify the ID number. Most BCBS-branded ID cards display a three-character alpha prefix in the first three positions of the members ID number. providers: We process your claim as soon as we receive them. YUV SG ON Exchange Prefix Tool. ** Remember: Member ID numbers must be reported exactly as shown on the ID card and must not be changed or altered. Box 33 Enter the contract name of physician or provider who performed the service. 24/7 anonymous hotline: 1 (800) 323-1693 There is other activity on your account during the payment cycle. Blue Cross and Blue Shield of Illinois P.O. They have Coordination of Benefits when we are the secondary carrier on the claim. Polski | AEX BCBS of IL Eastern WA and Alaska providers submit to Premera. Electronic claims without a TIN are rejected as incomplete. By continuing to use this website, you consent to these cookies. 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). Management - prior auth/pre-service requests), Members: Log in or register - MyBlue Customer eService, Retail Pharmacy Program PO Box 52057 Phoenix, AZ 85072, Retail Pharmacy Program PO Box 52080 Phoenix, AZ 85072, Phone:800-552-0733Fax: 801-333-6523 (Mark claims: Attn New Claims)Email: Log in or register - MyBlue Customer eService, Regence BlueShield - FEPPO Box 857Lewiston, ID 83501, Regence BlueShield - FEPPO Box 1388Lewiston, ID 83501Customer Service. BCBS Provider Phone Number. These charges are included in the main anesthesia service. If there are no court decrees, the plan of the parent with custody is primary. If we do not receive the EOB and are unable to obtain the primary payment information by phone, the claim will be denied with a request for a copy of the primary EOB before processing can be completed. ** A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total. In this health insurance plan, alpha prefix is assigned to national accounts. ABZ Carefirst BCBS Maryland Your Claims & Eligibility. ACR Anthem Blue Cross of California This includes Visit the Regence provider website, regence.com to learn more about: Claims and payment: Appeals. AFZ Anthem Blue Cross 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. <<1CC62891B116FE488EB50D904D0BD9AE>]/Prev 176800/XRefStm 1570>> CWN Carefirst BCBS Washington DC We do not request refunds for overpayments less than $25, but you may submit these voluntarily. AIA BCBS of Texas Use 8 to void a claim billed in error, The initial claim number (in loop 2300, REF01 must contain F8 and REF02 must contain the claim number). Please reach out and we would do the investigation and remove the article. Prescriptions. 6:00 AM - 5:00 PM ASTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care
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