Mail the overpayment amount to our finance department (address on check) along with a completed Refund Request form, or. AEK Independence Blue Cross Claims Prefix State/Area Plan Type Plan Name Provider and member service CMS contract, VOF NY MA HMO MediBlue HMO 1-800-499-9554 H3370 You have 365 calendar days to submit a complaint following the action that prompted the complaint. Provider: send us medical records relating to prescription drug charges. Open 24 hours a day, 7 days a week. If the member does not return the IQ within the specified timeframe, we'll deny all related claim(s). 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. Call Customer Service and choose the Pharmacy option. There is no charge to healthcare providers who submit electronic claims directly to us. CZG Premera Blue Cross of Washington HMO products include BlueChoice HMO, Direct Connection HMO, Child Health Plus, BlueChoice HMO/POS and Direct POS. YUV SG ON Exchange This prefix is the part of the distinctive identification number. 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. View your credentialing status in Payer Spaces on Availity Essentials. Receiving payment Regence Bluecross Blueshield of Oregon - Dun & Bradstreet AEP Carefirst BCBS Maryland Were ready. CVA Anthem BCBS of Ohio 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. ), 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 BCBS Prefix List 2021 - Alpha. January 19, 2022 by tamble. 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). Eastern WA and Alaska providers submit to Premera. 0000018816 00000 n Access fee schedules. CWI Blue Shield of California 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. Contact Provider Relations | Blue Cross of Idaho - bcidaho.com Regence BlueShield. How do I determine if a diagnosis or procedure code needs preauthorization? Regence BlueShield in accordance with the terms of your Provider contract with Regence. trailer If there are no court decrees, the plan of the parent with custody is primary. PDF State Mail to Mailing Address City, State Zip - Pnnl DJR Anthem BCBS of Ohio 0000004602 00000 n 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. We do not request refunds for overpayments less than $25, but you may submit these voluntarily. AEF BCBS of IL If that dialog box did not appear, click the "(change)" link next to the "ZIP code" label. ACR Anthem Blue Cross of California AHW BCBS of MA AGG Anthem BCBS of Ohio 0000018383 00000 n Related . We send the member a questionnaire requesting information to determine if benefits are available. Where can I find an Explanation of Payment (EOP)? 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. Interest less than 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 BCBS Prefix List QAA to QZZ - Alpha Lookup by State 2022 Use find (Ctrl + F) and enter the prefix to find the BCBS state. 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). Lewiston, ID 83501 . A member is primary on the plan in which he/she is the subscriber versus the plan in which he/she is a dependent. BCBS Prefix List HAA to HZZ - Alpha Lookup by State 2022 ABD Blue Shield of California Coding toolkit View our clinical edits and model claims editing. We can process the claim after we receive that information. Stay up to date on what's happening from Bonners Ferry to Boise. Claims may also be delayed during processing if: AlaskaProviders (Non-contracted and claims status, . AFA Anthem BCBS of Virginia QMB SG ON Exchange 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: Filing your claims should be simple. you will need to contact Regence to update your account to ensure your claim processes correctly and timely. Examples: medical doctor, osteopath, optometrist, chiropractor, physical therapist, audiologist, independent laboratory, nurse practitioner, durable 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 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. These weights are then multiplied by the dollar conversion factor we publish. ABR Carefirst BCBS Maryland 0000005825 00000 n 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. The plan doesn't cover cosmetic services. Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. Does not determine the reimbursement dollar amount for any particular service (reimbursement is specific to the provider applicable fee schedule). We can process the claim after we receive that information. They have Coordination of Benefits when we are the secondary carrier on the claim. PDF Local Blue Cross and Blue Shield Mailing Addresses State/Alpha Prefix Coronary Artery Disease. AEV Keystone Health Plan East (IBC) CZK Anthem BCBS of Virginia For Providers | Regence Group Administrators | Healthcare Benefits We will response ASAP. All of our contracts exclude coverage for care covered under the Workers' Compensation Act. ADW Carefirst BCBS Maryland For more information about RBRVS methodology visit the CMS website. 4. Included with the interest voucher is a summary report detailing CUQ Blue Shield of California For more specific contact information, choose from the following: Individuals and families Medicare Employers Producers Providers Fraud or abuse You can remain anonymous. The conversion factor represents the dollar value of each relative value unit (RVU). To make tracking patient reimbursement easier, we can include these account numbers on our payment vouchers. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. In third-party cases, this provision permits the plan to recover the medical bill costs on behalf of the member. For complete plan details, seeBenefits Summaries. Claims submission Learn more about billing and how to submit claims to use for payment. Asthma. AGC BCBS Kansas City Claims & payment - Regence BCBS Prefix List YAA to YZZ - Alpha Lookup by State 2022 Provider Contact Center. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Contact Us | FEP | Premera Blue Cross BCBS Prefix List 2021 - Alpha. QMC Retail OFF Exchange | You can verify your address by calling PEBB Customer Service at If you are interested in purchasing a new computer system, ask us for a list of vendors that submit claims to us in the HIPAA standard ANSI 837 format. AGH Anthem Blue Cross of California Other specialized services (home hospice, organ/tissue transplants, and clinical trials). All people who have BCBS health insurance policy have to make copies of their ID front and back and keep such records on hand. AGE Independence Blue Cross CVV Anthem Blue Cross of California We can't process this claim until the incident questionnaire we sent the member is fully completed, signed and returned. We can process the claim after we receive that information. Claims submitted that indicate possible Workers' Compensation illness or injuries are investigated. P.O. Congestive Heart Failure. LAB. If the Level II appeal is timely and complete, the appeal will be reviewed. FEP claims - Provider - REG - Regence Before discussing member claim information, the Customer Service representative must verify the identity of the caller. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. RGA observes theholiday schedule below. They include a request of medical records for review. For other language assistance or translation services, please call the customer service number for . Human Resources Inquiries. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. We will notify you once your application has been approved or if additional information is needed. 0000018886 00000 n We can't process this claim until the questionnaire we recently sent the member is completed and returned to us. Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. Care Management Programs. . CYW Anthem BCBS of Ohio AGU Carefirst BCBS Maryland Below you will find a list of the 2015 BCNEPA plans with the corresponding Highmark Blue Cross Blue Shield plans for 2016. Claims - PEBB - Regence If you have questions, please contact your local Blue Cross and Blue Shield company. Pay or deny 95 percent of a provider's monthly volume of all claims within 60 days of receipt. ABT Carefirst BCBS Maryland Appeals rights will be exhausted if not received within the required timeframe. 0000018992 00000 n If the information is not captured correctly, you may experience a delay with the claim processing. 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. When two or more health plans cover a member, COB protects against double or over-payment. You have to bear in mind that the alpha prefix has three letters usually followed by the identification of member of BCBS. It is important to file a claim with all insurance companies to which the member subscribes. Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. CZP Anthem BCBS of Ohio CWF BCBS of Georgia Note that some processing systems may have a limitation regarding the number of characters recognized. If you need more information about the NPI mandate, Medicare timelines, and/or the enumeration process, visit the CMS website. BCBS Provider Phone Number. 1fcZi=s6Z@n7;W^ugC:CGLi@0^pQY4#o0 y>_ The revenue codes and UB-04 codes are the IP of the American Hospital Association. When the conversion factor is multiplied by the total RVUs, it will yield the reimbursement rate for the specific service (or code). ABE BCBS Minnesota When Calypso identifies an overpayment, they mail an Overpayment Notification letter with a request for the overpaid amount. the lookout for future communications with more information about this exciting enhancement for submitting claim appeals through . Provider Claims Submission | Anthem.com It is critical for confirming a patients membership and coverage. Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. CVM Anthem BCBS of Ohio 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. . | Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. ** A local network identifier, (for example, BlueMark) 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. Do not make up alpha prefixes or assume that the members ID number is the Social Security Number. 0000055776 00000 n Note: Some members will remain in Blue Cross of Northeastern Pennsylvania health plans until their coverage renews to Highmark health plans later this year. Any suggestions. Prefixes with * include all characters for the 3rd position unless otherwise . ), Email all EDI questions to: EDIRequests@accesstpa.com. PO Box 52057 Regence Blue Shield in accordance with the terms of your provider contract with Regence. startxref Physicians and providers may submit a proposal to modify a payment policy. For Example: XYZ123456789. This is worthwhile to avoid selecting the alpha prefix randomly. . Professional Services are performed by a doctor or other healthcare professional. Washington - Blue Cross and Blue Shield's Federal Employee Program 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. Mental Health/Substance Use Disorder Precertification. 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. CYS BCBS of IL 398-0520-PN-NY. See the following pages for an explanation of the EOP fields and a description of codes and messages. It identifies the members Blue Cross Blue Shield company or national account in order to properly route the claim. AGF Anthem BCBS of Ohio Many offices assign their own account numbers to patients. The IQ is available in the Provider Library under Forms. Regence BlueShield - FEP PO Box 857 Lewiston, ID 83501. CZU Anthem Blue Cross of California 0000004073 00000 n A subsidiary of Cambia Health Solutions (formerly Regence Group) and one of Oregon's largest health plan provider, the company offers both group and individual health policies, including PPO plans and . When applicable, we will suspend payment until we determine which carrier is primary and which is secondary. ABA BCBS of IL Media Contact: Lou Riepl Regence BlueCross BlueShield of Utah Regence BlueShield of . 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 There is other activity on your account during the payment cycle. DJN BCBS Minnesota 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. CUW Anthem Blue Cross of California Access eContracting to view and sign agreement documents. If we do not receive a response within the specified period, the claim(s) is denied pending further information. Once we have received a payment ledger from the first-party carrier(s) showing where they paid out their limits (with dates of services, provider names, total charges, total paid, etc. AAB BCBS of Michigan If we cannot resolve the matter through non-binding mediation, either one of us may institute an action in any Superior Court of competent jurisdiction. the instructions to determine where to send claims or correspondence. If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. This traditional, broad network includes a wide variety of doctors and specialists across the United States. The ID cards may also have: ** PPO in a suitcase logo, for eligible PPO members 1-800-676-BLUE (2583) (toll free) Blueline voice response unit. Blue-Cross Blue-Shield of Illinois. You may like to substitute any prefix of BCBS with an existing BCBS. CVT Anthem Blue Cross of California Claim Submission and Payments | Provider | Premera Blue Cross ** The empty suitcase logo Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 CMS also uses RVUs to allocate dollar values to each CPT or HCPCS code. We haven't received the information. Please treat these members the same as domestic Blue Plan members. PO Box 33932 Seattle, WA 98133-0932 Phone: 800-562-1011 6:00 AM - 5:00 PM AST Fax: 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) Email Members: Log in or register - MyBlue Customer eService Retail pharmacy services Claims We use cookies on this website to give you the best experience and measure website usage. We notify you in writing if the request for mediation is not timely. Box 3004 Naperville, IL 60566-9747. The earlier you submit claims, the earlier we process them. These ID cards also will contain three-character alpha prefixes. ** A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total. Regence BCBS Oregon: YVK: Not Assigned Prefix: YVL: Regence BCBS Oregon: YVM: Regence BCBS Oregon: YVO: Regence Blue Cross Blue Shield Oregon: YVP: . Plan to submit test claims. QME Retail OFF Exchange Provider: please send us the radiology reports for this claim. ADC BCBS of IL Lastly mail the completed claim form to the address provided. Ting Vit | The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). DJG Anthem BCBS of Ohio See our FAQs for more claim information and contacts. CWR Anthem Blue Cross of California ** Verify with the member that the ID number on the card is not his/her Social Security Number. CVK BCBS of Florida 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. AGB Excellus BCBS AAU Blue Shield of California The main identifier for out-of-area members is the alpha prefix. 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. We are now processing credentialing applications submitted on or before March 14, 2023. ALN PA BC PA, Highmark, POB 1210 , Pittsburgh , PA , 15230 800-433-9906 providers: We process your claim as soon as we receive them. Web: Regence BlueShield. YDO Retail OFF Exchange From there, you will be directed to a new site; at this site, enter in your login information. Friday 6:00 AM. ACA BCBS of Alabama Be on . Use only red CMS-1500 forms (no photocopied forms). The ID cards also may have: AFG BCBS of Nebraska https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. . Regence BlueShield of Idaho | Regence This procedure is considered cosmetic. CYN Highmark BCBS CYY Premera Blue Cross of Washington If you submit your claims electronically, you may receive electronic remittance for the following: Remittance is available online-just let us know. Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. YDV SG ON Exchange Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time.
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