Pay or deny 95 percent of a provider's monthly clean claims within 30 days of receipt; and. There are three separate components that affect the value of each medical service or procedure: RVUs are assigned to each of these components. ), 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 CZB Wellmark BCBS Iowa/South Dakota YDV SG ON Exchange Our electronic claims process electronically separates and routes only valid claims for processing. AGH Anthem Blue Cross of California Join us! Postal Prescription Services Online: Your PPS account Phone: 1 (800) 552-6694 TRS: 711 Fax (for providers only): 1 (800) 723-9023 By continuing to use this website, you consent to these cookies. CYV Anthem BCBS of Missouri Box 91102 Both for dental and medical professional services, promises forms can be found. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. DJJ Horizon BCBS of New Jersey We're ready. | UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees. 24/7 anonymous hotline: 1 (800) 323-1693 Medicare Part C & D: 1 (800) 633-4227 Online reporting form Ethics & compliance hotline You can remain anonymous. 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. . ACV BCBS of Georgia CUP CBA BLUE (BCBS VT) ACD BCBS of Michigan Some members may carry outdated identification cards that may not have an alpha prefix. A comprehensive list is posted in the Library under Reference Info. 0000001762 00000 n Special Message: Coming soon, you will be able to dispute (appeal) a claim on Availity from the claim status result page. ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network All the contents and articles are based on our search and taken from various resources and our knowledge in Medical billing. . Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. If it is, call the BlueCard Eligibility line 800-676-BLUE (2583) to verify the ID number. 24/7 Nurse Line: 800-267-6729. Once we accept your level II appeal, we will respond within 15 days in writing or a revised Explanation of Payment. ABQ Blue Cross of Idaho (Boise) To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. If you are aware about the bcbs alpha prefix of your health insurance, then you can get the desired support on time for claiming the insurance. Regence BlueShield Attn: UMP ClaimsP.O. BCBS Provider Phone Number. ABJ BCBS Minnesota ADA Anthem Blue Cross of California Download the bcbs pdf document which has been at the bottom of the post and you could find prefix for OHIO too. ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. Does not determine the reimbursement dollar amount for any particular service (reimbursement is specific to the provider applicable fee schedule). 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. User the HIPAA 837 standard claims transaction including the following information: Frequency code of 7 in look 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. Because your primary doctor and your specialists may all work for different clinics, you may need to do more of your own care coordination. Oregon Providers (non-contracted and contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 12 percent annual rate on the unpaid or un-denied clean claim. the lookout for future communications with more information about this exciting enhancement for submitting claim appeals through . Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. . When dependent children are double-covered by divorced parents, coverage depends on any court decrees. Please refer to your electronic billing manual for specific formatting for electronic claims. Please provide a detailed description of the service being provided and the code to a member of our Customer Care Team at 1-866-738-3924 and they will provide you with an accurate benefit quote. An EDI representative will review the test claims with you or your vendor. CWI Blue Shield of California All Blue Plans replaced Social Security numbers on member ID cards with an alternate, unique identifier. 553 46 the instructions to determine where to send claims or correspondence. Featured In: May 2020 Empire Provider News. ** The empty suitcase logo Eastern WA and Alaska providers submit to Premera. Regence Blue-Cross Blue-Shield: PDS: Maryland/District of Columbia/Northern Virginia: Carefirst Blue-Cross Blue-Shield: PDT: Pennsylvania: DCL BCBS of TN CVQ BCBS of Georgia Please refer to the members ID card to determine if he/she has one of these products. This alpha prefix of BCBS plays the major role behind the proper way to claim the health insurance plan without delay and difficulty. This claim is a duplicate of a previously submitted claim for this member. AGV BCBS of MA Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. Completion of the credentialing process takes 30-60 days. ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network . AGL Premera Blue Cross of Washington AHB Anthem BCBS of Ohio To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. The claim(s) will suspend and a processor will review to determine whether to send an Incident Questionnaire (IQ) to the member. Policy #s: Regular 10017241-0001, Transit 10017241-0004, Sheriff 10017241-0016 . Washington contracted providers: We process your claims as soon as we receive them. AHC Anthem BCBS of Missouri AGR Anthem BCBS of Colorado Regence Blue-Cross Blue-Shield: YAM-Unallocated/Not Assigned: YAN-Unallocated/Not Assigned: YAO-Unallocated/Not Assigned: YAP: Minnesota: AFI BCBS of Rhode Island CYK BCBS of Georgia Box 805107 Chicago, IL 60680-4112. You have 365 calendar days to submit a complaint following the action that prompted the complaint. Regence BlueShield - FEP PO Box 1388 Lewiston, ID 83501 Customer Service. If you already have a computer system, notify your software vendor of your desire to convert to electronic claims. ADE BCBS of IL Prompt Pay interest is currently calculated monthly for the previous month's paid claims. Jun 29, 2010 | Medical billing basics | 6 comments. ADW Carefirst BCBS Maryland We need the member to promptly complete and return this questionnaire to process claims in a timely manner. Were ready. DAU Anthem BCBS of Missouri Filing your claims should be simple. Thank you for choosing Regence as your health plan administrator. View the toolkit Claims submission 1 (888) 675-6570 Prescription questions? The Identification cards will include: ** The three-character alpha prefix at the beginning of the members ID number How do I identify international members? Bill all original lines-not including all of the original lines will cause the claim to be rejected. 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). Be on . Practitioners who arent credentialed may have their claims returned until they submit a complete credentialing application. DJD BCBS of Nebraska If you know which division you would like to contact, you can also reach out directly using the following phone numbers and email addresses. ABZ Carefirst BCBS Maryland you will need to contact Regence to update your account to ensure your claim processes correctly and timely. Italiano | to 6:00 PM PT or log in to your RGA account and submit an electronic request. Box 105557. Bellevue, WA 98004, Terms of Use | Privacy| Disclosure Notice Patient Protection Surprise Billing, An Independent Licensee of the Blue Cross Blue Shield Association Serving Select Counties in Washington. All Rights Reserved to AMA. When Calypso identifies an overpayment, they mail an Overpayment Notification letter with a request for the overpaid amount. Access eContracting to view and sign agreement documents. ADT BCBS Minnesota ABT Carefirst BCBS Maryland UMP medical plans are administered by Regence BlueShield. (If no account number is assigned, the words No Patient Account # are noted. This procedure is considered cosmetic. AHI BCBS of Rhode Island 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 It is important to file a claim with all insurance companies to which the member subscribes. This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. CUQ Blue Shield of California To submit a Level I, Level II or Mediation Appeal (see above to submit a Complaint), send complete documentation to: Physician and Provider Appeals Mental Health/Substance Use Disorder Precertification. Diabetes. Invalid claims are reported back to the provider with rejection details. Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. endstream endobj 597 0 obj <>/Filter/FlateDecode/Index[30 523]/Length 41/Size 553/Type/XRef/W[1 1 1]>>stream 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 AEG Anthem BCBS of Ohio (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10. 0000018650 00000 n You will need special software to send insurance claims electronically. Friday 6:00 AM. 10/18) v2. 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). If you have questions about COB, contact Customer Service by calling the phone number on the back of the member's ID card. Prefix Plan Name, AAA BCBS of Alabama DJU 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. ALR AR BC AR, PO Box 2181 , Little Rock , AR , 72203-2180 888-847-1400, AMU RI BCRI, 444 Westminister St , Providence , RI , 02903-3279 401-831-7300, AMZ KY BC KY, POB 37690 , Louisville , KY , 40233 800-925-0135, AON IL BC IL, POB 1364 , Chicago , IL , 60690 800-972-8088, APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 BCBS Company. AHX Horizon BCBS of New Jersey CWR Anthem Blue Cross of California 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. Our medical staff reviewed this claim and determined that this service isn't covered by the plan. 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. CWK BCBS of MA accrue interest on the 31st day from receipt of the information. If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. CVY BCBS of Louisiana Once the claim is found, you can click on original EOP view to pull up this information. Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. CNK-HR-0230 ADC BCBS of IL QAB. After these steps are completed, you can choose one of the following options to resolve the overpayment: Calypso will apply the refund to the claim as soon as they receive the refund. Use our onboarding resource to quickly get started. ABU BCBS Minnesota Make sure you have your Member ID card handy when you call us. 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. any missing required substantiating documentation or particular circumstances requiring special treatment. Call Customer Service and choose the Pharmacy option. (for both professional and facility claims) using claim frequency code 7. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. Polski | ADY BCBS of South Carolina CZY BCBS of North Carolina Correspondence. If submitting a corrected claim on paper, remember to: Obtain Corrected Claim - Standard Cover Sheets at onehealthport.com in the administration simplification claims processing section, or under Forms on our provider website. 0000001240 00000 n startxref AIE BCBS of Michigan FAQs & Resources What type of EDI transactions does RGA accept? Please reach out and we would do the investigation and remove the article. Guardian Employees . ** Verify with the member that the ID number on the card is not his/her Social Security Number. Regence BlueShield in accordance with the terms of your Provider contract with Regence. Saturday 7 a.m. to 8 p.m.; Sunday 7 a.m. to 7 p.m. (Pacific)Calling from outside the US: Dial exit code of your country (typically 00) plus the country code (1 for USA), then the area code (916), then the seven-digit US local phone number 635-7373. Claims submission Learn more about billing and how to submit claims to use for payment. CVT Anthem Blue Cross of California . CVJ BCBS of Florida Policy #s: Regular10017241-0001, Transit10017241-0004, Sheriff10017241-0016, Chinook Building To ensure that OCR reads your paper claims accurately: Submitting a corrected claim may be necessary when the original claim was submitted with incomplete information (e.g., procedure code, date of service, diagnosis code). Refund total overpayment amounts within 60 days of initial notice to avoid having outstanding refund amounts offset against future payments. Your Claims & Eligibility. CVZ Horizon BCBS of New Jersey ABY Carefirst BCBS Maryland 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. 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. To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. AAC BCBS of IL CZQ Anthem BCBS of Ohio Provider who rendered the service. From there, you will be directed to a new site; at this site, enter in your login information. This is a duplicate of a previously denied claim. Alaska contracted and non-contracted 0000004941 00000 n COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. This member wasn't eligible for services on the date of service. BCBS Provider Phone Number. 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. 0000055046 00000 n Regence State Lookup. If we processed the original claim incorrectly, you do not need to rebill. 2023 Regence BlueShield. They can take note of bcbs alpha prefix online in detail and gain knowledge of how to choose the right alpha prefix. 0000055309 00000 n UMP members: If you are outside the U.S. and you have questions about your benefits and coverage, you can contact UMP Customer Service by signing into your Regence account and selecting chat live or email through the Message Center. Providers. 0000004602 00000 n CWE BCBS of Michigan Before discussing member claim information, the Customer Service representative must verify the identity of the caller. AFS Blue Shield of California When members of Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. DJK Empire BCBS The maximum limit has been met for this benefit. We'll coordinate the benefits of the members plan with those of other plans to make certain that the total payments from all plans aren't more than the total allowable expenses. They include a request of medical records for review. Facility Services are services received for the use of a facility such as a hospital, emergency room, freestanding ambulatory facility, attended sleep study at outpatient part of a hospital, alcohol treatment facility or residential 2. 0000018886 00000 n trailer Phoenix, AZ 85072, Phone:800-562-1011 Note : We have added some more prefixes in the list. Seattle, WA 98104 We notify you in writing if the request for mediation is not timely. ** Remember: Member ID numbers must be reported exactly as shown on the ID card and must not be changed or altered. The plan doesn't cover cosmetic services. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) Western WA providers submit claims to Regence Blue Shield. ADL Anthem BCBS Kentucky This prefix is the part of the distinctive identification number. Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. When members from Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association.
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