BCBS Provider Phone Number. We require that you verify the information about your practice and the networks you participate in at least every 90 days. CVQ BCBS of Georgia Phone: 844-380-8838, 800-863-5488 (TTY) 598 0 obj <>stream QME Retail OFF Exchange Does not determine the reimbursement dollar amount for any particular service (reimbursement is specific to the provider applicable fee schedule). Payment of this claim depended on our review of information from the provider. DKA Wellmark BCBS Iowa/South Dakota Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. Regence BlueShield. The provider needs to submit itemized charges to us. 0000006371 00000 n How do I determine if a diagnosis or procedure code needs preauthorization? Regence Group Administrators offers a complete suite of health risk management services in addition to benefit administration. We accept electronic claims through Availity using payer ID RGA01. CWR Anthem Blue Cross of California ACU Anthem Blue Cross of California CZC Anthem BCBS of Ohio Payment policy: You can find our payment policies on our website in the Library, under Reference Info. ** Empty suitcase logo, for eligible Manage Care/POS, Traditional and Managed Care/HMO members. 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. CYV Anthem BCBS of Missouri . AFP Anthem BCBS of Ohio Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do. We can process the claim after we receive that information. If you submit your claims electronically, you may receive electronic remittance for the following: Remittance is available online-just let us know. Claims filing information and provider service phone numbers are available in the December, January and February Provider Bulletins. We use an automated processing system to adjudicate claims. The protection of your privacy will be governed by the privacy policy of that site. KingCareSMuses a preferred provider organization (PPO) for its network. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. Physicians and providers may submit a proposal to modify a payment policy. AHQ Anthem BCBS of Ohio Need information from the member's other insurance carrier to process claim. Box 805107 Chicago, IL 60680-4112 Iowa . CZY BCBS of North Carolina medical equipment supplier, ambulance services, applied behavior analysis services (ABA) or clinical social worker. 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. To do so, please submit the proposal in writing to your assigned Provider Network Executive (PNE) or Provider Network Associate (PNA). Oromoo | 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. national customer service numbers at fepblue.org, Espaol | If you are unsure how to submit secondary claims electronically, contact your practice management system vendor or contact an EDI representative at 800-435-2715. 0000010231 00000 n DKB Highmark BCBS 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. 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 note: Exclusions to paying interest may apply based on line of business. 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. Once we accept your level II appeal, we will respond within 15 days in writing or a revised Explanation of Payment. If submitting a corrected claim electronically, remember to: For additional instructions on electronic corrected, replacement or voided claims, visit the online section Electronic Transactions and Claim Payer ID, for additional Coordination of Benefits (COB) is a provision included in both member and physician and provider contracts. Phoenix, AZ 85072, Phone:800-562-1011 1 (888) 675-6570 Prescription questions? Below you will find a list of the 2015 BCNEPA plans with the corresponding Highmark Blue Cross Blue Shield plans for 2016. A detailed description of the disputed issue, All evidence offered by you in support of your position including medical records, A description of the resolution you are requesting. We need the member to promptly complete and return this questionnaire to process claims in a timely manner. ), 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 Polski | Check out the changes and updates to our plan in 2023. 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. 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. 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. We can process the claim after we receive that information. Only appeals received within this period will be accepted for review. ADA Anthem Blue Cross of California Join us! QAA. Our provider complaints and appeals process ensure we address a complaint or an appeal in a fair and timely manner. ABV Anthem BCBS of Ohio 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 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). Claims. Insurance Denial Claim Appeal Guidelines. Claims submitted that indicate possible Workers' Compensation illness or injuries are investigated. 0000003471 00000 n ADL Anthem BCBS Kentucky It is only after we determine a members eligibility or coverage that payment policies and edits are applied. Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. Regence BlueShield of Idaho offers health and dental coverage to 142,000 members throughout the state. Regence Blue-Cross Blue-Shield: YAM-Unallocated/Not Assigned: YAN-Unallocated/Not Assigned: YAO-Unallocated/Not Assigned: YAP: Minnesota: Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. UMP members: If you are outside the U.S. and you have questions about your benefits and coverage, you can contact UMP Customer Service by signing into your Regence account and selecting chat live or email through the Message Center. 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. Please refer to your electronic billing manual for specific formatting for electronic claims. It is critical for confirming a patients membership and coverage. Get immediate member information by phone or fax . BCBS Provider Phone Number. The ID cards also may have: LAB. 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). AHW BCBS of MA If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. 553 0 obj <> endobj Bill all original lines-not including all of the original lines will cause the claim to be rejected. Eligibility, enrollment, and address/name changes. H\@F. A required waiting period must pass before we can provide benefits for this service. Do not make up alpha prefixes or assume that the members ID number is the Social Security Number. Chronic Obstructive Pulmonary Disease. Any exceptions are documented as Payment Policies. Policy #s: Regular 10017241-0001, Transit 10017241-0004, Sheriff 10017241-0016 . They can use such copies in different situations and get the complete support on time as awaited. 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) The employer group name is usually associated with the alpha prefix of the account specific health insurance type. RGA observes theholiday schedule below. 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). 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. 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 Who do I contact for EDI questions? AAC BCBS of IL 24/7 anonymous hotline: 1 (800) 323-1693 Primary submission: Show all insurance information on the claim, and then submit the claim to the primary plan first. A Level I Appeal is used for both billing and non-billing issues. DJW Wellmark BCBS Iowa/South Dakota We forwarded this claim to the member's home plan for processing. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) If the Level II appeal is timely and complete, the appeal will be reviewed. What do I do if a member has an identification card without an alpha prefix ? Claims A comprehensive list is posted in the Library under Reference Info. (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). 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. Download the bcbs pdf document which has been at the bottom of the post and you could find prefix for OHIO too. . PO Box 3876. All the information are educational purpose only and we are not guarantee of accuracy of information. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10. If you already have a computer system, notify your software vendor of your desire to convert to electronic claims. The ID cards may also have: ** PPO in a suitcase logo, for eligible PPO members They will be satisfied when they properly use this insurance plan and fulfil overall requirements on the prompt assistance for claiming the insurance. We will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. Box 3004 Naperville, IL 60566-9747. Members and Providers: 1-800-395-1616 Email Us. Instead, deposit the check, circle the claim in question on the Explanation of Payment (EOP) and include a short explanation as to why there was an overpayment. This alpha prefix of BCBS plays the major role behind the proper way to claim the health insurance plan without delay and difficulty. AGX Anthem BCBS of Virginia 0000056226 00000 n Stay up to date on what's happening from Bonners Ferry to Boise. Membership Address. DAU Anthem BCBS of Missouri ADM BCBS of IL 1 (888) 675-6570 Prescription questions? CWE BCBS of Michigan AFI BCBS of Rhode Island 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 0000004602 00000 n If you are a clinic or hospital-based physician or other qualified healthcare provider, use a CMS-1500 (02-12) form for claims for professional services and supplies related to: This includes claims for outpatient services and services performed by a hospital-based physician or other qualified healthcare provider. | Dont write or stamp extra information on the form. All our content are education purpose only. CVV Anthem Blue Cross of California CVT Anthem Blue Cross of California Email: Prproviderrelations@bcidaho.com. If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). claims status, . Western WA providers submit claims to Regence Blue Shield. 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 Mailing address: Blue Cross of Idaho. 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). Be sure information lines up correctly within the respective fields (data that overlaps another field/box cannot be read accurately). For services not listed in the RBRVS published annually in the Federal Register, we use Optum's Essential RBRVS (previously known as Ingenix Essential RBRVS and St. Anthony's Complete RBRVS). When members of Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. 3. Regence Uniform Medical Plan Vision Claim Form - An ERISA Section 502 (a) prepare can be reported in many different methods. Provider: send us the member's medical records for this claim. P.O. You will need special software to send insurance claims electronically.
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