Box 260070 Pembroke Pines, FL 33026 . Regence BlueShieldAttn: UMP ClaimsP.O. <<1CC62891B116FE488EB50D904D0BD9AE>]/Prev 176800/XRefStm 1570>> Stay up to date on what's happening from Bonners Ferry to Boise. PO Box 52057 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. Prefixes with * include all characters for the 3rd position unless otherwise . If Workers' Compensation denies payment of such claims, Premera will pay according to the subscriber's contract benefits after receiving a copy of a valid denial. AAX Anthem Blue Cross of California Boise, ID 83707. ** The empty suitcase logo . 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. ADT BCBS Minnesota If your request for mediation is timely, both parties must agree upon a mediator. Kreyl Ayisyen | This claim was paid previously to the provider or applied to the member's deductible. Because your primary doctor and your specialists may all work for different clinics, you may need to do more of your own care coordination. CMS also uses RVUs to allocate dollar values to each CPT or HCPCS code. We also apply the following prompt pay standards set by Washington's Office of the Insurance Commission to our claims adjudication process in order to: If the above standards are met, the regulation does not require interest for those individual claims paid outside of the 95 percent threshold. DJJ Horizon BCBS of New Jersey 0000009519 00000 n Your office staff can then post this remittance manually or electronically (if your software has electronic posting capability). 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: 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. Tennessee. 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. We use cookies on this website to give you the best experience and measure website usage. 0000055046 00000 n . We can process the claim after we receive that information. AEG Anthem BCBS of Ohio Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. 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. If that dialog box did not appear, click the "(change)" link next to the "ZIP code" label. Regence Group Administrators offers a complete suite of health risk management services in addition to benefit administration. Mail a completed Overpayment Notification form (found in our online library under Forms) and mark the box requesting a voucher deduction to recover the overpayment on future claim payments. 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. Provider: send us medical records relating to prescription drug charges. Note : We have added some more prefixes in the list. All Rights Reserved to AMA. YDM SG Off Exchange BCBS Company. the lookout for future communications with more information about this exciting enhancement for submitting claim appeals through . (Field not populated for CMS-1500 claims. CUZ Anthem BCBS of Ohio DJD BCBS of Nebraska EMPIRE BCBS Decides the pre certification requirements based on the prefix id. AAU Blue Shield of California CVG BCBS of Florida 0000125980 00000 n 398-0520-PN-NY. Call 1 (855) 522-8894. AEJ Horizon BCBS of New Jersey Once the IQ is returned, all claims are reviewed and processed based on the information supplied. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Postal Prescription Services Online: Your PPS account Phone: 1 (800) 552-6694 TRS: 711 Fax (for providers only): 1 (800) 723-9023 Box 22999 Rochester, NY 14692 *New York *The Buffalo office handles the receipt of claims and correspondence for BS In this health insurance plan, alpha prefix is assigned to national accounts. 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. account number and claim number handy when you call. AGY BCBS of South Carolina ACU Anthem Blue Cross of California All the information are educational purpose only and we are not guarantee of accuracy of information. ABI BCBS Minnesota ACR Anthem Blue Cross of California Our medical staff reviewed this claim and determined that this service isn't covered by the plan. 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. The main identifier for out-of-area members is the alpha prefix. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. claim and apply additional edits if applicable. Were ready. ** PPO in a suitcase logo, for eligible PPO members We require that you verify the information about your practice and the networks you participate in at least every 90 days. Please reach out and we would do the investigation and remove the article. We can process the claim after we receive that information. 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. When dependent children are double-covered by divorced parents, coverage depends on any court decrees. AFY BCBS of IL All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. 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. CYK BCBS of Georgia 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. ), 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 QMF Retail ON Exchange Box 25 Enter the applicable tax ID number. Money was posted to your account during the payment cycle. Here are examples: A Level I Appeal must be submitted with complete supporting documentation that includes all of the following: Incomplete appeal submissions are returned to the sender with a letter requesting information for review. This member wasn't eligible for services on the date of service. Many residents in our time do not aware about how they can decide on the alpha prefix and reap more than a few benefits from the best suitable health insurance plan. endstream endobj 597 0 obj <>/Filter/FlateDecode/Index[30 523]/Length 41/Size 553/Type/XRef/W[1 1 1]>>stream View your credentialing status in Payer Spaces on Availity Essentials. ADC BCBS of IL If you get the plan specific alpha prefix, then the first two characters in this prefix are used to identify your plan. 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. To ensure accurate claim processing, it is critical to capture all ID card data. 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). Regence Provider Appeal Form. From there, you will be directed to a new site; at this site, enter in your login information. 598 0 obj <>stream Employees:Contact your payroll or benefits office. . to 6:00 PM PT or log in to your RGA account and submit an electronic request. Claims Address. To contact us without setting your ZIP code, call: Prescription questions?Call Customer Service and choose the Pharmacy option. Filing your claims should be simple. Blue Cross Blue Shield Federal Phone Number. xref Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). Idaho Regence BlueShield of Idaho PO Box 31603 Salt Lake City, UT 84131 Illinois BlueCross BlueShield of Illinois PO Box 1364 Chicago, IL 60690 . ABB BCBS of IL AGV BCBS of MA When applicable, we will suspend payment until we determine which carrier is primary and which is secondary. Your member ID card is your key to using your medical plan benefits. complies with applicable Federal and Washington state civil rights laws, Determine the county where the service was performed* (see exceptions below). 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. AAZ Anthem Blue Cross of California You have five UMP medical plan options: UMP Classic. We follow industry standard coding recommendations and guidelines from sources such as the CMS, CPT, and AMA, and other professional organizations and medical societies and colleges. Deutsch | Does not determine the reimbursement dollar amount for any particular service (reimbursement is specific to the provider applicable fee schedule). ABZ Carefirst BCBS Maryland 0000055309 00000 n . It is important to file a claim with all insurance companies to which the member subscribes. Also its not a sequential order hence its hard to find unless we check with first 3 alpha prefix. 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. Premera Blue Cross CWK BCBS of MA | 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) AAN Anthem Blue Cross of California Asthma. A Level I Appeal is used to dispute one of our actions. . CZC Anthem BCBS of Ohio Be on . BJF NCJ YLB YLG YLX BJT RFB YLC YLK YLY EHP SWH YLD YLN YLZ MES YLA YLE YLW, Network Name Old Alpha Prefix New Alpha Prefix, YDQ Retail ON Exchange We send the member a questionnaire requesting information to determine if benefits are available. Both for dental and medical professional services, promises forms can be found. ** Verify with the member that the ID number on the card is not his/her Social Security Number. If you're a medical biller or a provider and going to submit BCBS plan member claim to the insurance, make sure to submit member ID including prefix. You can find a claim by the members ID number or by the claim number. DJF Anthem BCBS of Virginia View your credentialing status in Payer Spaces on Availity Essentials. 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. 0000018992 00000 n AAS Anthem Blue Cross of California New York, New York 10008-3876. Member identification prefixes were updated as part of that transition. Franais | The total number of characters in the members ID ranges from six to fourteen. FAQs & Resources What type of EDI transactions does RGA accept? COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. 0000008944 00000 n Open 24 hours a day, 7 days a week. ** Members who are part of the FEP will have the letter R in front of their member ID number. CWH Anthem Blue Cross of California When members from Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. When submitting claims, transfer the members identification (ID) number exactly as printed on the ID card. AIH Anthem Blue Cross of California Blue Cross and Blue Shield of Illinois P.O. Once you have signed in, simply click on the Claim Search link. 1-800-962-2731. 0000008298 00000 n QMG SG OFF Exchange. 0000011774 00000 n Our medical staff reviewed this claim and determined that this admission doesn't meet the criteria for medical necessity. We use an automated processing system to adjudicate claims. The earlier you submit claims, the earlier we process them. Subrogation permits the plan to recover payments when the negligence or wrongdoing of another causes a member personal illness or injury. 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. Use our onboarding resource to quickly get started. DBT BCBS of Michigan Payment policy: You can find our payment policies on our website in the Library, under Reference Info. We are unable to quote a benefit by a code. ABA BCBS of IL Washington Contracted Providers: If we fail to satisfy either of the above standards, well pay interest on each claim that took longer than 60 days to process at a 12 percent annual rate (unclean days are not applied toward the 60 day calculation). Briefly, these rules are as follows: Some group contracts are not subject to state regulations may have unique COB rules that could change the order of liability. Find Contact Information. 0000018650 00000 n The mediator consults with the parties, determines a process, and schedules the mediation. Prefix State/Area Plan Type Plan Name Provider and member service CMS contract, VOF NY MA HMO MediBlue HMO 1-800-499-9554 H3370 ACH Wellmark BCBS Iowa/South Dakota AEV Keystone Health Plan East (IBC) Eligibility, enrollment, and address/name changes. The IQ is available in the Provider Library under Forms. CUP CBA BLUE (BCBS VT) YDZ SG OFF Exchange AAP BCBS of Tennessee 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. We notify you in writing if the Level II appeal is not timely and your appeal rights will be exhausted. CWI Blue Shield of California LAB. YDW Retail OFF Exchange CVS Caremark. 0000001921 00000 n How do I identify international members? 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). See the following pages for an explanation of the EOP fields and a description of codes and messages. CZE Anthem Blue Cross of California 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. CVQ BCBS of Georgia 6:00 AM - 5:00 PM ASTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care To submit a Level I, Level II or Mediation Appeal (see above to submit a Complaint), send complete documentation to: Physician and Provider Appeals 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). 0000015026 00000 n 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. Unclean claims will begin to accrue interest on the 16th day . Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. | Make sure you have your Member ID card handy when you call us. Invalid claims are reported back to the provider with rejection details. Example: 001-916-635-7373. 24/7 anonymous hotline: 1 (800) 323-1693 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. CVM Anthem BCBS of Ohio PO Box 3876. See our FAQs for more claim information and contacts. Provider: send us the member's medical records for this claim. AGW BCBS of MA ADI Anthem Blue Cross of California Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. There is a minimum threshold of $25 for monthly interest payments on delayed clean claims. 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. The preferred process for submitting corrected claims is to use the 837 transaction What type of EDI transactions does RGA accept? Your member ID card is your key to using your medical plan benefits. 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. Lastly mail the completed claim form to the address provided. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. CYN Highmark BCBS Need help with a claim? DJS Blue Cross of Idaho (Boise) To do so, please submit the proposal in writing to your assigned Provider Network Executive (PNE) or Provider Network Associate (PNA). threshold. | 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. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) ADM BCBS of IL DAU Anthem BCBS of Missouri 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. providers: We process your claim as soon as we receive them. 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). Verify eligibility via Highmarks NaviNet. Monday-Friday, 8-5 Pacific (800) 552-0635 www.CarpentersBenefits.org. Tagalog | However we have some guide to follow, using prefixes we could find the state of the BCBS and contact phone number to proceed further. We can't process this claim until the questionnaire we recently sent the member is completed and returned to us. Friday 6:00 AM. AGX Anthem BCBS of Virginia AHB Anthem BCBS of Ohio DJP BCBS of Nebraska CVY BCBS of Louisiana AEP Carefirst BCBS Maryland This is a claim adjustment of a previously processed claim. 0000003471 00000 n Final Instructions about BCBS Prefix Lookup. Only a member can request a Level I or Level II Appeal for a non-billing issue, unless the member has completed a release to allow the provider to act as their Representative. AHA BCBS of IL Blue Cross and Blue Shield of Illinois (BCBSIL) members ID cards in the BlueCare Direct and Blue Choice Preferred PPO plans have been updated. 0000004602 00000 n Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. They are suspended due to the group or individual's non-payment of premium or dues. An EDI representative will review the test claims with you or your vendor. There is no charge to healthcare providers who submit electronic claims directly to us. If we processed the original claim incorrectly, you do not need to rebill. Once the claim is found, you can click on original EOP view to pull up this information. ACX BCBS of IL If you are not registered, please click on the Not Registered link to set up your account. Practitioners who arent credentialed may have their claims returned until they submit a complete credentialing application. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Professional Services are performed by a doctor or other healthcare professional. 7:00 AM - 6:00 PM PSTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care State Lookup. AFA Anthem BCBS of Virginia Your member ID card is your key to using your medical plan benefits. DHB Empire BCBS Where do I submit a preauthorization request? (If no account number is assigned, the words No Patient Account # are noted. DKB Highmark BCBS For more information, view our privacy policy. Always use the alpha prefix on the members current ID card. Complaints received beyond the 365-day timeframe will not be reviewed and the appeals rights pertaining to the issue will be exhausted. CZX Anthem BCBS of Ohio 0000004941 00000 n An overpayment was recorded during the payment cycle. PO Box 52080 The Level I Appeal must be submitted within 365-days following the action that prompted the dispute. Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. We will notify you once your application has been approved or if additional information is needed. Care Management Programs. 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. For more information, please visit regence.com, Prefix Product Area Billing Address Phone #, AAX CA BC CA, POB 60007 , Los Angeles , CA , 90060 800-765-2588, ABW VA BC VA, Trigon POB 27401, Richmond , VA , 23279 800-445-7490, ACN PA BC PA, Highmark BC PO Box 1210 , Pittsburgh , PA , 15230 800-682-3386, ACT NY BCBS Empire, POB 11800 , Albany , NY , 12211-0800 800-992-2583 Box 3004 Naperville, IL 60566-9747. Doing so may cause delays in the handling of your inquiries and claims. Postal Prescription ServicesOnline: Your PPS accountPhone: 1 (800) 552-6694TRS: 711Fax (for providers only): 1 (800) 723-9023Business hours: Monday through Friday 6 a.m. to 6 p.m. and Saturday 9 a.m. to 2 p.m. (Pacific), Ardon HealthPhone: 1 (855) 425-4085TRS: 711Fax (for providers only): 1 (855) 425-4096Business hours: Monday through Friday 8 a.m. to 7 p.m. and Saturday 8 a.m. to 12 p.m. (Pacific), Online: Medicare or MyMedicarePhone: 1 (800) MEDICARE (1-800-633-4227)TTY: 1 (877) 486-2048. AHO BCBS of Tennessee 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). AIE BCBS of Michigan CVT Anthem Blue Cross of California 1-877-764-8724 Email Us. Our medical staff reviewed this claim and determined that this continued stay doesn't meet the criteria for medical necessity. AEM Highmark BCBS | For more information about RBRVS methodology visit the CMS website. 0000006620 00000 n 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. The charges for this service have been combined into the primary procedure based on the provider's contract. . DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. Fraud or abuse You can remain anonymous. You can also use the Office of Financial Management MyPortal to update your address. 2023 Regence BlueShield. Box 52890Bellevue WA 98015 or fax at 1-866-458-5488. 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). AEC BCBS of IL Ting Vit | 0000001570 00000 n Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. View your credentialing status in Payer Spaces on Availity Essentials. Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. Our process meets or exceeds the requirements set by the Office of the Insurance Commissioner. In third-party cases, this provision permits the plan to recover the medical bill costs on behalf of the member. Pay or deny 95 percent of a provider's monthly volume of all claims within 60 days of receipt. If the information received indicates an on-the-job illness or injury, both the member and physician/provider will receive a denial that states the Premera contract excludes work-related conditions. Please 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. We're ready. 800-676-2583. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). Regence Blue Shield in accordance with the terms of your provider contract with Regence. January 19, 2022 by tamble. | 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. Please review the terms of use and privacy policies of the new site you will be visiting. Provider: send us the NDC #, quantity and date span for this claim. Please refer to your electronic billing manual for specific formatting for electronic claims. CVJ BCBS of Florida Join us! 0 TINs are still a required element for claims.