0000015111 00000 n ACD BCBS of Michigan If your organization is contracted with Premera, most practitioners must be credentialed, with the exception of hospital-based practitioners. This claim was paid previously to the provider or applied to the member's deductible. CVA Anthem BCBS of Ohio Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. CVY BCBS of Louisiana To contact us without setting your ZIP code, call: Prescription questions?Call Customer Service and choose the Pharmacy option. 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. This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, 0000011774 00000 n We require that you verify the information about your practice and the networks you participate in at least every 90 days. ABA BCBS of IL 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. Before discussing member claim information, the Customer Service representative must verify the identity of the caller. DCY BCBS of Florida AHW BCBS of MA CZO Anthem BCBS of Ohio If the information is not captured correctly, you may experience a delay with the claim processing. 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. See the following pages for an explanation of the EOP fields and a description of codes and messages. Regence Group Administrators offers a complete suite of health risk management services in addition to benefit administration. We're here to help (651) 662-5200 1-800-262-0820 . QAB. Blue-Cross Blue-Shield of Illinois. Polski | Regence BlueCross BlueShield of Utah is an independent licensee of the Blue Cross and Blue Shield Association. 0000012556 00000 n AFI BCBS of Rhode Island Prefix Plan Name, AAA BCBS of Alabama A subrogation provision is included in both member and physician/provider contracts. Members: Log in/register at MyBlue Customer eService, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 31105Salt Lake City, UT 84131, Regence Blue Cross Blue Shield of Oregon - FEPPO Box 1269Portland, OR 97207, Find Regence Provider Appeal Form. BCBS Provider Phone Number. P | DHP Excellus BCBS DAD Anthem BCBS of Ohio endstream endobj 554 0 obj <>/Metadata 28 0 R/Pages 27 0 R/StructTreeRoot 30 0 R/Type/Catalog/ViewerPreferences<>>> endobj 555 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 203>>/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 556 0 obj <> endobj 557 0 obj <> endobj 558 0 obj <> endobj 559 0 obj <> endobj 560 0 obj <> endobj 561 0 obj <> endobj 562 0 obj [591 0 R] endobj 563 0 obj <>stream ABK Carefirst BCBS Maryland The total number of characters in the members ID ranges from six to fourteen. Oromoo | See our FAQs for more claim information and contacts. The employer group name is usually associated with the alpha prefix of the account specific health insurance type. AEF BCBS of IL PO Box 52057 Western WA providers submit claims to Regence Blue Shield. Special Message: Coming soon, you will be able to dispute (appeal) a claim on Availity from the claim status result page. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. All the information are educational purpose only and we are not guarantee of accuracy of information. You can also submit claims via mail to our claims address P.O. (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). 0000055046 00000 n Lewiston, ID 83501 . If the Level II appeal is timely and complete, the appeal will be reviewed. Box 25 Enter the applicable tax ID number. Open 24 hours a day, 7 days a week. 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 398-0520-PN-NY. YDZ SG OFF Exchange Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. If we need additional information for subrogation determine to pay or deny, the IQ will either be sent back to the member requesting the information, or subrogation will make two calls within five days of receiving the IQ. If you get the plan specific alpha prefix, then the first two characters in this prefix are used to identify your plan. startxref 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. ACK Anthem Blue Cross of California Hours: 8 a.m. 4:30 p.m. weekdays, Find certified small business contractors and suppliers. AAX Anthem Blue Cross of California 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. 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. We send the member a questionnaire requesting information to determine if benefits are available. TINs are still a required element for claims. CWQ Anthem BCBS of Ohio 598 0 obj <>stream AFC BCBS of IL 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. AEG Anthem BCBS of Ohio 10/18) v2. Box 91102 AGB Excellus BCBS CVM Anthem BCBS of Ohio Lack of credentialing can be grounds for termination from Premeras network. Your member ID card is your key to using your medical plan benefits. In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. For more information, view our privacy policy. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). It is only after we determine a members eligibility or coverage that payment policies and edits are applied. Fraud or abuse You can remain anonymous. CWB BCBS of Georgia ** Always include the members ID number, including the alpha prefix, on any documents pertaining to services to ensure accurate handling by the BCBS Plan. AAP BCBS of Tennessee Claims & payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. When we are the primary carrier, we calculate and pay benefits routinely. You may have invested in the account specific alpha prefix health insurance plan from BSBS at this time. If you know which division you would like to contact, you can also reach out directly using the following phone numbers and email addresses. 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 If you need more information about the NPI mandate, Medicare timelines, and/or the enumeration process, visit the CMS website. Please request a current ID card from the member. hbbe`b``3 1x0@ t I 0000004941 00000 n If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). Italiano | RBRVS is a method of reimbursement that determines allowable fee amounts based on established unit values as set norms for various medical and surgical procedures, and further based on weights assigned to each procedure code. However we have some guide to follow, using prefixes we could find the state of the BCBS and contact phone number to proceed further. CVX BCBS of IL Payments are issued under a separate voucher and mailed to the address on the original claim. DJW Wellmark BCBS Iowa/South Dakota Provider: please send us the radiology reports for this claim. Church Street Station. Italiano | Box 3004 Naperville, IL 60566-9747. LAB. Blue Cross and Blue Shield of Illinois P.O. We can't process this claim until the incident questionnaire we sent the member is fully completed, signed and returned. AHD BCBS of South Carolina Send us other carrier's explanation of benefits. 0000008944 00000 n Contact. AEQ BCBS of Michigan Claims submitted that indicate possible Workers' Compensation illness or injuries are investigated. AHA BCBS of IL 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. The main identifier for out-of-area members is the alpha prefix. CVC Anthem BCBS of Ohio Interest less than Coding toolkit View our clinical edits and model claims editing. | YDW Retail OFF Exchange You can use Availity to submit and check the status of all your claims and much more. 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. 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. 24/7 anonymous hotline: 1 (800) 323-1693 0000125980 00000 n The mediator consults with the parties, determines a process, and schedules the mediation. 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: The dates-of-service (to and from - also referred to as beginning and ending dates) at a, The code/modifier shown in box 24D of the CMS-1500. Physicians and other healthcare providers receive an Explanation of Payment (EOP), which describes our determination of the payment for services. The member's benefit program contains special provisions for benefits when an injury or condition is: An onset date should be recorded on all accident-related claims. Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out. Physicians and providers may submit a proposal to modify a payment policy. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. In these cases, please don't return the check to us. Verify benefits or eligibility for BlueCard members. CZX Anthem BCBS of Ohio TRS: 711 Fax: 1 (800) 633-0334 Business hours: Monday through Friday: 5 a.m. to 7 p.m. (Pacific) Saturday: 9:30 a.m. to 2 p.m. (Pacific) Note: UMP members do not need to be Costco members to use their mail-order service. If we receive the complaint before the 365-day deadline, we review and issue a decision within 30 calendar days via letter or revised Explanation of Payment. CVG BCBS of Florida Your software vendor can help you set up your computer to accommodate Premera's billing requirements. 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 P.O. If you require a written refund request before mailing the overpayment, contact Calypso directly at 800-364-2991. 02/16/2023 Retirement Workshop in Lacey on Feb. 18. . 0000087176 00000 n We recommend that you make copies of everything that is submitted for your personal records. DBT BCBS of Michigan Join us! ** Remember: Member ID numbers must be reported exactly as shown on the ID card and must not be changed or altered. The time period does not start until we receive a complete appeal. AAS Anthem Blue Cross of California The provider appeals process does not apply to FEP, BlueCard Home Claims, Medicare Supplement plans, or Medicare Advantage plans. Regence BlueCross BlueShield of Utah. 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. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. Mailing address: Blue Cross of Idaho. ABB BCBS of IL We use cookies on this website to give you the best experience and measure website usage. Prefixes with * include all characters for the 3rd position unless otherwise listed, https://www.premera.com/documents/020469.pdf. Because your primary doctor and your specialists may all work for different clinics, you may need to do more of your own care coordination. The National Uniform Claim Committee (NUCC) has developed a 1500 Reference Instruction Manual detailing how to complete the claim form to help nationally standardize how the form is completed. . Diabetes. BCBS Provider Phone Number. This claim is a duplicate of a previously submitted claim for this member. Download the bcbs pdf document which has been at the bottom of the post and you could find prefix for OHIO too. CZE Anthem Blue Cross of California 0000004829 00000 n ADF Healthnow of NY Buffalo When this notification has occurred, change the indicator on your claims from (. Who do I contact for EDI questions? ACH Wellmark BCBS Iowa/South Dakota Regence Blue-Cross Blue-Shield: ZBU: Illinois: Blue-Cross Blue-Shield of Illinois: ZBV: Wisconsin: Anthem Blue-Cross Blue-Shield of Wisconsin: ZBW: South Dakota/Iowa: | To pay this claim, we needed to review information from the provider. ), Number assigned to the claim when received by plan. 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. We can process the claim after we receive that information. Premera Blue Cross 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, We will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. Most BCBS-branded ID cards display a three-character alpha prefix in the first three positions of the members ID number. There is other activity on your account during the payment cycle. Eastern WA and Alaska providers submit to Premera. You have to bear in mind that the alpha prefix has three letters usually followed by the identification of member of BCBS. CZM Highmark BCBS DCL BCBS of TN Always use the alpha prefix on the members current ID card. ABY Carefirst BCBS Maryland 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: 0000008616 00000 n We are now processing credentialing applications submitted on or before March 6, 2023. You can submit a complaint about one of our actions (verbally or in writing) to one of our employees. You will need special software to send insurance claims electronically. AEV Keystone Health Plan East (IBC) When applicable, we will suspend payment until we determine which carrier is primary and which is secondary. Resource-based relative value scale (RBRVS) Claims adjudication system Claims Editors Payment Policies Payment policies Our Provider Integrity Oversight Committee reviews proposals for new payment policies and updates to our policies. Box 52890Bellevue WA 98015 or fax at 1-866-458-5488. Open 24 hours a day, 7 days a week. Box 33 Enter the contract name of physician or provider who performed the service. Friday 6:00 AM. By continuing to use this website, you consent to these cookies. There is a minimum threshold of $25 for monthly interest payments on delayed clean claims. Colorado. Regence Blue-Cross Blue-Shield: PDS: Maryland/District of Columbia/Northern Virginia: Carefirst Blue-Cross Blue-Shield: PDT: Pennsylvania: Empire BlueCross moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015. Thank you for the care you provide to our members and people in our communities. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do. Dont write or stamp extra information on the form. ADQ Independence Blue Cross Provider: please send us your operative notes for this claim. 553 0 obj <> endobj As a nonprofit independent licensee of the Blue Cross and Blue Shield Association, Regence is part of a family of companies dedicated to transforming health care by delivering innovative products and services that change the way consumers nationwide experience health care. 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. KingCareSMuses a preferred provider organization (PPO) for its network. 10700 Northup Way, Suite 100 Postal Prescription Services Online: Your PPS account Phone: 1 (800) 552-6694 TRS: 711 Fax (for providers only): 1 (800) 723-9023 ADW Carefirst BCBS Maryland 0000001570 00000 n Claims & payment Claims and payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. 0000014956 00000 n ABD Blue Shield of California For most plans, we'll deny claims received more than 12 months after the date of service with no member responsibility. DJM BCBS of Texas ACN BCBS of IL Empire BCBS Phone Number and Claim Address (2023) BCBS Alpha Prefix IAA-IZZ (2023) BCBS Alpha Prefix HAA-HZZ (2023) BCBS Alpha Prefix List GAA-GZZ (2023) They have Coordination of Benefits when we are the secondary carrier on the claim.
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