1-800-962-2731. The earlier you submit claims, the earlier we process them. We are unable to quote a benefit by a diagnosis or procedurecode. Before implement anything please do your own research. Regence Bluecross Blueshield of Oregon - Dun & Bradstreet COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). AFS Blue Shield of California Use search function and put your comment any alpha prefix not found here. CZG Premera Blue Cross of Washington Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. CWR Anthem Blue Cross of California Please provide a detailed description of the service for preauthorization to a member of our Customer Care Team at 1-866-738-3924 and they will let you know if the service requires preauthorization. Get help when you need it. 1 (877) 878-2273 All Blue Plans replaced Social Security numbers on member ID cards with an alternate, unique identifier. ADE BCBS of IL CWF BCBS of Georgia When this notification has occurred, change the indicator on your claims from (. Regence BlueShield - FEP PO Box 857 Lewiston, ID 83501. CPT 92521,92522,92523,92524 Speech language pathology, CPT 81479 oninvasive Prenatal Testing for Fetal Aneuploidies, CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY, CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. | Find the correct address listed under the type of service received (see explanation). It is critical for confirming a patients membership and coverage. Provider who rendered the service. DAC BCBS of Tennessee 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. PDF Local Blue Cross and Blue Shield Mailing Addresses State/Alpha Prefix ABE BCBS Minnesota Please reach out and we would do the investigation and remove the article. CWH Anthem Blue Cross of California DJF Anthem BCBS of Virginia All the articles are getting from various resources. ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. They have Coordination of Benefits when we are the secondary carrier on the claim. Contact Us. Blue Advantage Administrators of Friday 6:00 AM. CUQ Blue Shield of California CUZ Anthem BCBS of Ohio Open 24 hours a day, 7 days a week. For Providers | Regence Group Administrators | Healthcare Benefits The revenue codes and UB-04 codes are the IP of the American Hospital Association. We haven't received the information. Workers' Compensation will pay when the member's employer is liable to pay medical bills resulting from illness or injury arising out of, or in, the scope of employment. A Level I Appeal is used for both billing and non-billing issues. There is other activity on your account during the payment cycle. 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. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. The three characters preceding the subscriber identification number on BCBS member ID cards. These weights are then multiplied by the dollar conversion factor we publish. This review is necessary to determine whether the claim(s) should be covered by a first-party carrier (e.g., PIP, Med Pay or similar coverage - homeowners or a commercial medical premise policy). Related . An interest check is issued only for months in which the accumulated interest is equal to or greater than the minimum threshold of $25. To find a health care provider in the KingCare network, go to Find a doctor and sign in to your Regence BlueShield account. Uniform Medical Plan (UMP) | Washington State Health Care Authority 401 Fifth Ave. Alaska contracted and non-contracted Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. CVA Anthem BCBS of Ohio PDF Regence Provider Appeal Form AAQ Anthem BCBS of Ohio Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. 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. AEJ Horizon BCBS of New Jersey BCBS Prefix List QAA to QZZ - Alpha Lookup by State 2022 0000010898 00000 n Type forms in black ink (handwritten forms cannot be read by OCR equipment). We can process the claim after we receive that information. If you bill your claims using the ANSI 837 electronic format, then you must include the Coordination of Benefits (COB) information from the primary coverage payer in your claim. Does not determine the reimbursement dollar amount for any particular service (reimbursement is specific to the provider applicable fee schedule). 0000008643 00000 n The mediator's fees are shared equally between the parties. | Prefix State/Area Plan Type Plan Name Provider and member service CMS contract, VOF NY MA HMO MediBlue HMO 1-800-499-9554 H3370 All people who have BCBS health insurance policy have to make copies of their ID front and back and keep such records on hand. The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. From there, you will be directed to a new site; at this site, enter in your login information, if you are not registered, please click on the Not Registered link to set up your account information. Employees:Contact your payroll or benefits office. contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 15 percent annual rate on the unpaid or un-denied clean claim. AEP Carefirst BCBS Maryland 1-800-962-2731. 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: to 6:00 PM PT or log in to your RGA account and submit an electronic request. 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. CZM Highmark BCBS Lack of credentialing can be grounds for termination from Premeras network. ** Empty suitcase logo, for eligible Manage Care/POS, Traditional and Managed Care/HMO members. The maximum limit has been met for this benefit. Claims Carpenters Retirement Plan Individual Account Pension Plan Pre-Retirement Planning Your Balances & Accruals. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. Visit the Regence provider website, regence.com to learn more about: Claims and payment: Appeals. The employer group name is usually associated with the alpha prefix of the account specific health insurance type. Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out. On the Availity Web Portal, you can: Run transactions to obtain member benefit, eligibility and claims information. Phone: 1-800-628-3481. 0000010231 00000 n Blue Cross and Blue Shield of Illinois P.O. Atlanta, GA 30348-5557. 0000004829 00000 n Guardian Employees . Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. DJE BCBS of Alabama CNK-HR-0230 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. Saturday and Sunday 6 a.m. to 2 p.m. (Pacific), HealthEquityOnline: HealthEquityPhone: 1 (844) 351-6853TRS: 711Business hours: 24 hours, 7 days a week, Vision Service PlanOnline: Your vision accountPhone: 1 (844) 299-3041Deaf, DeafBlind, Late Deafened and Hard of Hearing members call: 1-800-428-4833Business hours: Monday through Friday 5 a.m. to 8 p.m. (Pacific). Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. Claims - PEBB - Regence If we do not receive a response within the specified period, the claim(s) is denied pending further information. H\@F. QMG SG OFF Exchange. We also provide information regarding mediation should you disagree with the decision. 0000001570 00000 n Payment policy: You can find our payment policies on our website in the Library, under Reference Info. 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. CZX Anthem BCBS of Ohio Deutsch | If the IQ states that there is no first-party coverage(s) available, but there is a third-party that is responsible for the incident, we will process all related claims based on the member's contract with us until all parties are ready to negotiate a settlement for possible reimbursement. DJN BCBS Minnesota Since new ID cards may be issued to members throughout the year, this will ensure that you have the most up-to-date information in your patients file. The time period does not start until we receive a complete appeal. ACD BCBS of Michigan AEQ BCBS of Michigan the lookout for future communications with more information about this exciting enhancement for submitting claim appeals through . Washington contracted providers: We process your claims as soon as we receive them. Contact Us - Uprise Health 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 Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. Uniform Medical Plan - Benefits Electronic Transactions and Claim Payer ID, Resource-based relative value scale (RBRVS), Claims from Non-credentialed contracted providers, federal and Washington state civil rights laws, Subscriber's number and patient suffix number (including plan prefix) assigned by plan as shown on the member's identification card, Number assigned by the clinic for patient. Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. . 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. Disclosure Notice Patient Protection Surprise Billing, 270/271 Eligibility inquiry and response, 278 Referral certification and authorization, 837 Claims and encounters (P, D, and I). Franais | national customer service numbers at fepblue.org, Espaol | For other language assistance or translation services, please call the customer service number for . Provider Contacts | Provider | Premera Blue Cross 0000008298 00000 n PO Box 1106. There is a minimum threshold of $25 for monthly interest payments on delayed clean claims. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. When completing the CMS-1500 form, note the following: HIPAA's Administration Simplification provision requires a standard unique identifier for each covered healthcare provider (those that transmit healthcare information in an electronic form in connection with HIPAA-standard claim transactions). You can recognize Managed Care/POS members who are enrolled in out-of-area networks through the member identification card as you do for all other BlueCard members. . DJR Anthem BCBS of Ohio In box 22 on the CMS-1500 Claim form, enter the appropriate bill frequency code, left justified in the left hand side of the field. 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. The charges for this service have been combined into the primary procedure based on the provider's contract. 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. Need help with a claim? Management - prior auth/pre-service requests), Email: Members: Log in/register at MyBlue Customer eService, Regence BlueShield - FEPPO Box 21709Seattle, WA 98111. https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. 800-676-2583. DJJ Horizon BCBS of New Jersey Italiano | These ID cards also will contain three-character alpha prefixes. If you are not registered, please click on the Not Registered link to set up your account. 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. Portugus | ** PPO in a suitcase logo, for eligible PPO members Correspondence. ), claims will be processed accordingly and under the terms of our subscriber's contract. QMB SG ON Exchange Get immediate member information by phone or fax . Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Regence Blue-Cross Blue-Shield: HCT BCBS Prefix: Pennsylvania: Highmark Blue-Cross Blue-Shield of Pennsylvania: HCU: Tennessee: Blue-Cross Blue-Shield of Tennessee: HCV: Is distinct from our medical policy, which sets forth whether a procedure is medically necessary/appropriate, investigational or experimental and whether treatment is appropriate for the condition treated. DHA Excellus BCBS Utica We will notify you once your application has been approved or if additional information is needed. If member returns the call and the information is obtained, claims will be processed. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. Blue Cross and Blue Shield of Illinois (BCBSIL) members ID cards in the BlueCare Direct and Blue Choice Preferred PPO plans have been updated. Doing so may cause delays in the handling of your inquiries and claims. 0000008944 00000 n How do I identify international members? We haven't received the information. Care Management Programs. 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: Who do I contact for EDI questions? you will need to contact Regence to update your account to ensure your claim processes correctly and timely. P.O. ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network We can process the claim after we receive that information. Join us! This is a duplicate of a previously denied claim. Regence Group Administrators offers a complete suite of health risk management services in addition to benefit administration. What do I do if a member has an identification card without an alpha prefix ? You will need special software to send insurance claims electronically. ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network Tennessee. Coronary Artery Disease. Claim edits in place will identify those services previously billed and bundle ALL services on to a single AGB Excellus BCBS Congestive Heart Failure. BCBS Company. Provider Claims Submission | Anthem.com . How do I determine if a diagnosis or procedure code needs preauthorization? 0000009519 00000 n Availity supports the exchange of electronic remittance advice (ERA) files for Regence payers in the ASC X12 835 format. CZB Wellmark BCBS Iowa/South Dakota AHO BCBS of Tennessee the claims for which interest payments have been applied during that period. AGG Anthem BCBS of Ohio By continuing to use this website, you consent to these cookies. 1 (888) 675-6570 Prescription questions? . This is worthwhile to avoid selecting the alpha prefix randomly. ADL Anthem BCBS Kentucky UMP Customer ServicePhone: 1 (888) 849-3681 TRS: 711 Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)Chat Live: Sign in to your Regence account Monday through Friday 7 a.m. to 5 p.m. (Pacific) to access chat live. BCBS Federal Phone Number - Revenue Cycle Management AFP Anthem BCBS of Ohio Verify benefits or eligibility for BlueCard members. Example: 001-916-635-7373. Health . Claims & payment - Regence In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. AFI BCBS of Rhode Island ** A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. This service is considered a standard exclusion. 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. ABU BCBS Minnesota 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. A subrogation provision is included in both member and physician/provider contracts. Claims may also be delayed during processing if: AlaskaProviders (Non-contracted and CVG BCBS of Florida 0000004968 00000 n Subrogation permits the plan to recover payments when the negligence or wrongdoing of another causes a member personal illness or injury. color, national origin, age, disability, sex, gender identity, or sexual orientation. 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 Thank you for choosing Regence as your health plan administrator. ABB BCBS of IL Call Customer Service and choose the Pharmacy option. Availity is solely responsible for its products and services. Please refer to the members ID card to determine if he/she has one of these products. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). Select the area of the map that matches the color of the county where the service was performed. Availity. . Sometimes an office returns a check to us that represents multiple claims because a portion (see Threshold below) of the payment may be incorrect. Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. Premera Blue Cross ABK Carefirst BCBS Maryland Where do I determine if a code is covered? Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. Prescriptions. 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. ** When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the members card. Contact us - BridgeSpan Health All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. 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. If all pertinent information is obtained, the claim(s) will then be processed according to the member's contract benefits. Oregon - Blue Cross and Blue Shield's Federal Employee Program Blue-Cross Blue-Shield of Illinois. Prefixes with * include all characters for the 3rd position unless otherwise . 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). As a KingCare member, your care is covered at a higher level inside the network, but the plan also pays a smaller amount toward your bill if you see a doctor outside of the KingCare PPO network. 0000004602 00000 n Regence health plans operate in Oregon, Idaho, Utah and select counties in Washington, each an independent licensee of the Blue Cross and Blue Shield Association dedicated to making health care better, simpler and more affordable. Refund total overpayment amounts within 60 days of initial notice to avoid having outstanding refund amounts offset against future payments. AFY BCBS of IL This procedure is considered cosmetic. Phoenix, AZ 85072, Phone:800-562-1011 What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. CVQ BCBS of Georgia If you need more information about the NPI mandate, Medicare timelines, and/or the enumeration process, visit the CMS website. Once the IQ is returned, all claims are reviewed and processed based on the information supplied. AES BCBS of Alabama Completion of the credentialing process takes 30-60 days. Coronary Artery Disease. Regence Blue Shield of Idaho - FEPPO Box 30270Salt Lake City, UT 84131-0207. Claim Submission and Payments | Provider | Premera Blue Cross 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. Regence Health Plans, Prime Therapeutics study shows significant BCBS Provider Phone Number. Send us other carrier's explanation of benefits. Note that some processing systems may have a limitation regarding the number of characters recognized. ABZ Carefirst BCBS Maryland Member identification prefixes were updated as part of that transition. YDM SG Off Exchange Were ready. AGE Independence Blue Cross Polski | Box 7408. Email: Prproviderrelations@bcidaho.com. You may like to substitute any prefix of BCBS with an existing BCBS. Once you have signed in, simply click on the Authorizations on the top menu and you will be able to submit your preauthorization request. An overpayment was recorded during the payment cycle. Washington - Blue Cross and Blue Shield's Federal Employee Program Completion of the credentialing process takes 30-60 days. 2023 Regence BlueShield. 0 treatment center. ACX BCBS of IL For complete plan details, seeBenefits Summaries. 0000013357 00000 n Invalid claims are reported back to the provider with rejection details. PO Box 3876. Electronic claims without a TIN are rejected as incomplete. 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. State Lookup. Units shown in box 24G of the CMS-1500 form. Box 1106Lewiston, ID 83501-1106 Fax: 1 (877) 357-3418 If you have questions about submitting a claim for services outside the U.S., call UMP Customer Service. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. They can use such copies in different situations and get the complete support on time as awaited. BCBS Alpha Prefix YAA-YZZ(2023) | Medical Billing RCM Provider: send us the member's medical records for this claim. When a dependent is double-covered under married parents' health plans, the primary plan is the coverage of the parent with his/her birthday earlier in the year, regardless of their actual age. AFB BCBS of South Carolina Provider: please send us the member's lab results for this claim. UMP medical plans are administered by Regence BlueShield. ABW Anthem BCBS of Virginia If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. AEK Independence Blue Cross ABV Anthem BCBS of Ohio For information that cannot be served by Availity Essentials or our self-service tool, our Provider Contact Center is available Monday through Friday, 6 a.m. - 5 p.m. (PT). Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association. Payment of this claim depended on our review of information from the provider. CZY BCBS of North Carolina Regence CVV Anthem Blue Cross of California ACS BCBS of IL
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