If we processed the original claim incorrectly, you do not need to rebill. AEP Carefirst BCBS Maryland Western WA providers submit claims to Regence Blue Shield. AGS Anthem Blue Cross of California However we have some guide to follow, using prefixes we could find the state of the BCBS and contact phone number to proceed further. Examples: medical doctor, osteopath, optometrist, chiropractor, physical therapist, audiologist, independent laboratory, nurse practitioner, durable 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. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10.) You can learn more about credentialing by visiting the provider section of our website. 2023 Regence BlueShield. Fax: 801-333-6523 (Mark claims: Attn New Claims) Email: Log in or register - MyBlue Customer eService. If member returns the call and the information is obtained, claims will be processed. CZC Anthem BCBS of Ohio 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. 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. Monday-Friday, 8-5 Pacific (800) 552-0635 www.CarpentersBenefits.org. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. AGC BCBS Kansas City 0000006620 00000 n In general, there are two categories of alpha prefixes namely account specific and plan specific alpha prefixes. BCBS Provider Phone Number. You can use Availity to submit and check the status of all your claims and much more. 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 Claim edits in place will identify those services previously billed and bundle ALL services on to a single Michigan. A billing issue is classified as a provider appeal because the issue directly impacts your write-off or payment amount. 0000011774 00000 n 0000008616 00000 n CUZ Anthem BCBS of Ohio 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. Designed by Elegant Themes | Powered by WordPress. For information that cannot be served by Availity Essentials or our self-service tool, our Provider Contact Center is available Monday through Friday, 6 a.m. - 5 p.m. (PT). If we do not receive the EOB and are unable to obtain the primary payment information by phone, the claim will be denied with a request for a copy of the primary EOB before processing can be completed. 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. . Online Claim Submission. KingCareSMuses a preferred provider organization (PPO) for its network. 10/18) v2. ABR Carefirst BCBS Maryland Completion of the credentialing process takes 30-60 days. ADG Anthem BCBS of Ohio Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. 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. | Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. You can reach Customer Service by calling 877-342-5258, option 2. Once the IQ is returned, all claims are reviewed and processed based on the information supplied. Sometimes an office returns a check to us that represents multiple claims because a portion (see Threshold below) of the payment may be incorrect. CWK BCBS of MA We haven't received the information. Were ready. Filing your claims should be simple. Send us other carrier's explanation of benefits. Alaska contracted and non-contracted 10700 Northup Way, Suite 100 3. 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. To find a health care provider in the KingCare network, go to Find a doctor and sign in to your Regence BlueShield account. AHB Anthem BCBS of Ohio Box 31 Enter the physician or providers name that performed the service. ACA BCBS of Alabama This traditional, broad network includes a wide variety of doctors and specialists across the United States. Uniform Medical Plan (UMP) offers you five different health plans through Washington state's Public Employees Benefits Board (PEBB). Insurance Denial Claim Appeal Guidelines. A member is primary on the plan in which he/she is the subscriber versus the plan in which he/she is a dependent. Note : We have added some more prefixes in the list. Select the area of the map that matches the color of the county where the service was performed. If you get the plan specific alpha prefix, then the first two characters in this prefix are used to identify your plan. 0000009222 00000 n They are identified by Guest Member on their health plan ID card. See our FAQs for more claim information and contacts. Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. Once you have signed in, simply click on the Claim Search link. CUQ Blue Shield of California CVS Caremark. Once the submission is complete and if the issue is billing related, we review the request and issue a decision within 30 days, along with your right to submit a Level II Appeal if you are not satisfied with the outcome. 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. Review our pricing disputes and appeals information to ensure you are following the correct process. Use our onboarding resource to quickly get started. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. 0000018650 00000 n Our medical staff reviewed this claim and determined that this admission doesn't meet the criteria for medical necessity. CYN Highmark BCBS Call Customer Service and choose the Pharmacy option. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Care Management Programs. Please make copies of the front and back of the ID card, and pass this key information to your billing staff. AFG BCBS of Nebraska AGV BCBS of MA DKD Wellmark BCBS Iowa/South Dakota, HPS Gordmans Inc. (formerly 1/2 Price Stores), How to Identify Members 3.1.1 Member ID Cards. Do not make up alpha prefixes or assume that the members ID number is the Social Security Number. CUW Anthem Blue Cross of California BCBS Prefix List 2021 - Alpha. AEG Anthem BCBS of Ohio You can print and assist the member in completing the form, but it's important to review the instructions included with the form because the patient must complete the form and then sign it. Email: Prproviderrelations@bcidaho.com. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. 0000014956 00000 n 1-877-764-8724 Email Us. BCBS Provider Phone Number. Tagalog | The charges for this service have been combined into the primary procedure based on the provider's contract. Only appeals received within this period will be accepted for review. If the information is not captured correctly, you may experience a delay with the claim processing. Professional example: GENERAL CLINIC is the provider of service. Please use comment section to add or Modify further. 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. 0000003603 00000 n Heres everything you need to know about it. All people who have BCBS health insurance policy have to make copies of their ID front and back and keep such records on hand. This prefix is the part of the distinctive identification number. AEQ BCBS of Michigan 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. 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). Regence BlueShield. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. 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. When Calypso identifies an overpayment, they mail an Overpayment Notification letter with a request for the overpaid amount. We can process the claim after we receive that information. 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. AFL Anthem Blue Cross of California Find helpful phone, fax and email information for assistance. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. The protection of your privacy will be governed by the privacy policy of that site. Featured In: May 2020 Empire Provider News. Fraud or abuse You can remain anonymous. ADA Anthem Blue Cross of California $25 will continue to accrue until it reaches that threshold or until December of each year. If you submit your claims electronically, you may receive electronic remittance for the following: Remittance is available online-just let us know. Check out the changes and updates to our plan in 2023. AGB Excellus BCBS ** A local network identifier, (for example, BlueMark) AFP Anthem BCBS of Ohio CMS also uses RVUs to allocate dollar values to each CPT or HCPCS code. Many offices assign their own account numbers to patients. See our FAQs for more claim information and contacts. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. If we do not receive a response within the specified period, the claim(s) is denied pending further information. Verify eligibility via Highmarks NaviNet. 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. | AAN Anthem Blue Cross of California CZV BCBS of Alabama Secondary submission: When submitting secondary claims to us, submit the primary processing information with the submission of the secondary claim. However, there are some exceptions. 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 What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. We do not request refunds for overpayments less than $25, but you may submit these voluntarily. Both for dental and medical professional services, promises forms can be found. Some members may carry outdated identification cards that may not have an alpha prefix. CVK BCBS of Florida 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 These ID cards also will contain three-character alpha prefixes. You can also call using Skype. ** The empty suitcase logo Provider: please send us your office notes for this claim. 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. 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. Regence BlueShield - FEP PO Box 1388 Lewiston, ID 83501 Customer Service. providers: We process your claim as soon as we receive them. We are now processing credentialing applications submitted on or before March 6, 2023. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. An interest check is issued only for months in which the accumulated interest is equal to or greater than the minimum threshold of $25. 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 the IQ states that there is no first-party coverage(s) available, but there is a third-party that is responsible for the incident, we will process all related claims based on the member's contract with us until all parties are ready to negotiate a settlement for possible reimbursement. This review is necessary to determine whether the claim(s) should be covered by a first-party carrier (e.g., PIP, Med Pay or similar coverage - homeowners or a commercial medical premise policy). We are now processing credentialing applications submitted on or before March 14, 2023. 24/7 anonymous hotline: 1 (800) 323-1693 Medicare Part C & D: 1 (800) 633-4227 Online reporting form Ethics & compliance hotline You can remain anonymous. (for both professional and facility claims) using claim frequency code 7. DHA Excellus BCBS Utica Care Management Programs. If you require a written refund request before mailing the overpayment, contact Calypso directly at 800-364-2991. How do I determine if a diagnosis or procedure code needs preauthorization? Phoenix, AZ 85072, Phone:800-562-1011
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