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. AHD BCBS of South Carolina 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 . CVZ Horizon BCBS of New Jersey 0000001921 00000 n If you get the plan specific alpha prefix, then the first two characters in this prefix are used to identify your plan. BCBS Prefix List HAA to HZZ - Alpha Lookup by State 2022 threshold. (BlueCard will request refunds regardless of the dollar amount.) Regence Blue Shield in accordance with the terms of your provider contract with Regence. BCBS Provider Phone Number. We recommend that you make copies of everything that is submitted for your personal records. 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. Pay or deny 95 percent of a provider's monthly volume of all claims within 60 days of receipt. Regence Health Plans, Prime Therapeutics study shows significant 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). Karen Lyons, APR Sr. Director, Public Relations 612.777.5742 klyons@primetherapeutics.com. The maximum limit has been met for this benefit. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. Washington contracted providers: We process your claims as soon as we receive them. ** The empty suitcase logo Please follow ABR Carefirst BCBS Maryland 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. Human Resources Inquiries. DJU Carefirst BCBS Maryland We are now processing credentialing applications submitted on or before March 14, 2023. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. DJK Empire BCBS KingCare - King County ADT BCBS Minnesota They can take note of bcbs alpha prefix online in detail and gain knowledge of how to choose the right alpha prefix. Most BCBS-branded ID cards display a three-character alpha prefix in the first three positions of the members ID number. Contact us - Asuris 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. QMB SG ON Exchange A Level I Appeal is used to dispute one of our actions. Deutsch | Before implement anything please do your own research. Utah - Blue Cross and Blue Shield's Federal Employee Program QMD Retail ON Exchange Only appeals received within this period will be accepted for review. ACQ BCBS of Georgia AAQ Anthem BCBS of Ohio CUP CBA BLUE (BCBS VT) (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) ABG BCBS of Georgia Provider: send us medical records relating to prescription drug charges. Ideally, we'd like you to submit claims within 60 calendar days of the covered services, but no later than 365 calendar days from the date of submission. Franais | Please make copies of the front and back of the ID card, and pass this key information to your billing staff. See our FAQs for more claim information and contacts. If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. Insurance Denial Claim Appeal Guidelines. Paid to refers to the payee code (where the check was sent/issued) and is listed only in the claim total or subtotal line (e.g., G = Provider Group). View the instructions for verifying your information and notifying us of changes. CVQ BCBS of Georgia BCBS Company. Were ready. Illinois. . Additional Contact Information Pharmacy Program. 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. 0000008433 00000 n Regence BlueCross BlueShield of Utah. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Providers. P | Type forms in black ink (handwritten forms cannot be read by OCR equipment). Email: Prproviderrelations@bcidaho.com. | If there is no alpha prefix, do not create one or use an alpha prefix from another members ID card, even one from the same BCBS Plan. Coronary Artery Disease. DKB Highmark BCBS 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. 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 provider needs to submit itemized charges to us. If all pertinent information is obtained, the claim(s) will then be processed according to the member's contract benefits. Regence BlueCross BlueShield of Oregon | Regence ACS BCBS of IL ADI Anthem Blue Cross of California Pay clean claims within 30 days of receipt; and, Pay unclean claims within 15 days after receipt of information, Pay unclean claims within 30 days after receipt of information. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. Check out the changes and updates to our plan in 2023. ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. Please treat these members the same as domestic Blue Plan members. 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. When dependent children are double-covered by divorced parents, coverage depends on any court decrees. 800-676-2583. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. 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. Eastern WA and Alaska providers submit to Premera. ABJ BCBS Minnesota Modifications we make to your contract or to our policy or procedures are not subject to the appeal process unless we made it in violation of your contract or the law. Jun 29, 2010 | Medical billing basics | 6 comments. 0000003471 00000 n Verify benefits or eligibility for BlueCard members. ** When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the members card. Contact us - Regence Regence BlueShield of Idaho offers health and dental coverage to 142,000 members throughout the state. CYV Anthem BCBS of Missouri Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. 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. Claims submission Learn more about billing and how to submit claims to use for payment. 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. CZB Wellmark BCBS Iowa/South Dakota BCBS Prefix List QAA to QZZ - Alpha Lookup by State 2022 When members from Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Enter a ZIP code in that box. We send the member a questionnaire requesting information to determine if benefits are available. To contact Corporate, please call 1-425-462-1000 Monday - Friday 8:00 AM to 5:00 PM PT. The main identifier for out-of-area members is the alpha prefix. CUR Healthnow of NY Buffalo Be on . 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. The plan mailing addresses are available on our website under Contact Us. A fragmented or split professional billing is defined as professional services rendered by the same provider for the same date of service and submitted on multiple professional claim forms. Chronic Obstructive Pulmonary Disease. We'll process the claim after we receive that information. CWH Anthem Blue Cross of California If member does not return the call, claims will be denied until information is received. 0000009519 00000 n 0000011774 00000 n Regence BlueShield - FEP PO Box 1388 Lewiston, ID 83501 Customer Service. Below is a list of the old and new alpha prefix codes.