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. 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. AGR Anthem BCBS of Colorado CYP BCBS of IL The ID cards may also have: ** PPO in a suitcase logo, for eligible PPO members Access fee schedules. 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. The SORA is generated when one of the following occurs during a payment cycle: Physicians and providers have the right to appeal certain actions of ours. account number and claim number handy when you call. 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. Blue cross Blue Shield association cannot accept Guest Membership claims electronically. Blue Cross Blue Shield Federal Phone Number. If we need additional information for subrogation determine to pay or deny, the IQ will either be sent back to the member requesting the information, or subrogation will make two calls within five days of receiving the IQ. January 19, 2022 by tamble. Empire BlueCross moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015. Chronic Obstructive Pulmonary Disease. Payments are issued under a separate voucher and mailed to the address on the original claim. AAN Anthem Blue Cross of California Payment of this claim depended on our review of information from the provider. 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. BCBS Prefix List HAA to HZZ - Alpha Lookup by State 2022 To pay this claim, we needed to review information from the provider. Claims filing information and provider service phone numbers are available in the December, January and February Provider Bulletins. Oromoo | The conversion factor represents the dollar value of each relative value unit (RVU). Claims - SEBB - Regence 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). 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 They can use such copies in different situations and get the complete support on time as awaited. Phone: 844-380-8838, 800-863-5488 (TTY) . Please follow Regence Group Administrators offers a complete suite of health risk management services in addition to benefit administration. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). providers: We process your claim as soon as we receive them. 0000004968 00000 n This claim was paid previously to the provider or applied to the member's deductible. 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. ** A local network identifier, (for example, BlueMark) CVJ BCBS of Florida If the information is not captured correctly, you may experience a delay with the claim processing. 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. AEK Independence Blue Cross CVC Anthem BCBS of Ohio In third-party cases, this provision permits the plan to recover the medical bill costs on behalf of the member. Our electronic claims process electronically separates and routes only valid claims for processing. The plan mailing addresses are available on our website under Contact Us. Insurance Denial Claim Appeal Guidelines. CMS also uses RVUs to allocate dollar values to each CPT or HCPCS code. Receiving payment 10700 Northup Way, Suite 100 AEF BCBS of IL To do so, please submit the proposal in writing to your assigned Provider Network Executive (PNE) or Provider Network Associate (PNA). Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. On the other hand, the third character in the prefix is used to find out the product type you have enrolled in. 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. Box 52890Bellevue WA 98015 or fax at 1-866-458-5488. When we are the primary carrier, we calculate and pay benefits routinely. BCBS Prefix List 2023 - Alpha Prefix and Alpha Number Prefix Lookup In general, this prefix is mainly used to confirm the eligibility of the member and coverage information. View the toolkit Claims submission Colorado. information. Provider: please send us the radiology reports for this claim. ABV Anthem BCBS of Ohio 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. Benefits are not available through us until the first-party carrier has exhausted, denied, or stopped paying due to its policy limits. Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out. Guardian Employees . Refund total overpayment amounts within 60 days of initial notice to avoid having outstanding refund amounts offset against future payments. Professional Services are performed by a doctor or other healthcare professional. 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. REGENCE BLUE CROSS BLUE SHIELD OF OREGON - 12 Reviews - 100 SW Market Str, Portland, Oregon - Health & Medical - Phone Number - Yelp Regence Blue Cross Blue Shield of Oregon 12 reviews Unclaimed Health & Medical Write a review Add photo Photos & videos Add photo You Might Also Consider Sponsored TLC Laser Eye Centers 29 For Example: XYZ123456789. PO Box 1106. Many offices assign their own account numbers to patients. Once you have signed in, simply click on the Authorizations on the top menu and you will be able to submit your preauthorization request. Unclean claims will begin to The main identifier for out-of-area members is the alpha prefix. DHB Empire BCBS PDF Regence Provider Appeal Form AGW BCBS of MA To submit a Level I, Level II or Mediation Appeal (see above to submit a Complaint), send complete documentation to: Physician and Provider Appeals to 6:00 PM PT or log in to your RGA account and submit an electronic request. Click on the Submit a Preauthorization Request link. CWB BCBS of Georgia | Bill all original lines-not including all of the original lines will cause the claim to be rejected. 0000087176 00000 n ** PPO in a suitcase logo, for eligible PPO members Box 22999 Rochester, NY 14692 *New York *The Buffalo office handles the receipt of claims and correspondence for BS 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 DCY BCBS of Florida Employees:Contact your payroll or benefits office. Friday 6:00 AM. Download the bcbs pdf document which has been at the bottom of the post and you could find prefix for OHIO too. Box 31 Enter the physician or providers name that performed the service. you will need to contact Regence to update your account to ensure your claim processes correctly and timely. 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. Member identification prefixes were updated as part of that transition. ADE BCBS of IL AES BCBS of Alabama Your member ID card is your key to using your medical plan benefits. New York, New York 10008-3876. Its often confused that BCBS have lot of prefixes and where to contact. CVT Anthem Blue Cross of California . YDM SG Off Exchange Membership Address. Our medical staff reviewed this claim and determined that this admission doesn't meet the criteria for medical necessity. 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. Contact Us | FEP | Premera Blue Cross Phoenix, AZ 85072, Phone:800-562-1011 ), claims will be processed accordingly and under the terms of our subscriber's contract. You can make a complaint verbally to Customer Service or in writing to Customer Service Correspondence. Human Resources Inquiries. Use search function and put your comment any alpha prefix not found here. When submitting claims, transfer the members identification (ID) number exactly as printed on the ID card. Once the claim is found, you can click on original EOP view to pull up this information. P.O. ** Do not change the sequence of the characters following the alpha prefix. Applicable to facility claims only - reflects the APG code, DRG code, or room type that may relate to the reimbursement amounts. Centers of Excellence Program administered by Premera Phone: 1 (855) 784-4563 TRS: 711 Business hours: Monday through Friday 7 a.m. to 5 p.m. (Pacific), Puget Sound High Value NetworkPhone: 1 (855) 776-9503TRS: 711Business hours: Monday through Friday 7 a.m. to 7 p.m. (Pacific), UW Medicine Accountable Care NetworkPhone: 1 (888) 402-4237TRS: 711Business hours: Monday through Friday 5 a.m. to 8 p.m. (Pacific). AAC BCBS of IL Tennessee. No pre-authorization for COVID-19 vaccinations, testing and treatment, No member cost shares for COVID-19 vaccinations, testing and treatment. Please provide a detailed description of the service for preauthorization to a member of our Customer Care Team at 1-866-738-3924 and they will let you know if the service requires preauthorization. 598 0 obj <>stream 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. They must be sent hard copy. PO Box 52057 The three characters preceding the subscriber identification number on BCBS member ID cards. AIH Anthem Blue Cross of California These weights are then multiplied by the dollar conversion factor we publish. National Correct Coding Initiative (NCCI) editing is followed when applicable. Your member ID card is your key to using your medical plan benefits. ACD BCBS of Michigan DKC BCBS of Texas Regence BlueCross BlueShield of Oregon | Log in to Availity Don't have an Availity account? Our process meets or exceeds the requirements set by the Office of the Insurance Commissioner. Regence BlueShield of Idaho offers health and dental coverage to 142,000 members throughout the state. AEA BCBS of Texas This procedure is considered cosmetic. The time period does not start until we receive a complete appeal. AAB BCBS of Michigan Lewiston, ID 83501 . ** Make copies of the front and back of the members ID card and pass this key information on to your billing staff. 1-877-764-8724 Email Us. Anthem Blue-Cross Blue-Shield of Colorado. 10/18) v2. When a Medicare patient received services that Medicare specifically requires to be submitted on separate claim forms, this one claim requirement will not apply. DJW Wellmark BCBS Iowa/South Dakota Units shown in box 24G of the CMS-1500 form. Please ** Always include the members ID number, including the alpha prefix, on any documents pertaining to services to ensure accurate handling by the BCBS Plan. 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. 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. DAU Anthem BCBS of Missouri Uniform Medical Plan - Benefits The claim(s) will suspend and a processor will review to determine whether to send an Incident Questionnaire (IQ) to the member. 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. We can process the claim after we receive that information. 0000010231 00000 n 0000001762 00000 n Related . For more information, view our privacy policy. 0000005570 00000 n Note : We have added some more prefixes in the list. AEP Carefirst BCBS Maryland CZE Anthem Blue Cross of California Only appeals received within this period will be accepted for review. DJC Anthem BCBS of Ohio ** The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Plan. Please use comment section to add or Modify further. ** Members who are part of the FEP will have the letter R in front of their member ID number. You can also call using Skype. UMP medical plans are administered by Regence BlueShield. Pay or deny 95 percent of a provider's monthly clean claims within 30 days of receipt; and. 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. Please review the terms of use and privacy policies of the new site you will be visiting. BCBS Provider Phone Number. AEZ Wellmark BCBS Iowa/South Dakota startxref FAQs & Resources What type of EDI transactions does RGA accept? Provider: please send us your office notes for this claim. 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. To speed claims processing, we use document imaging and optical character recognition (OCR) equipment to read your claims. There is a balance due to us at the end of the payment cycle. 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). The provider appeals process does not apply to FEP, BlueCard Home Claims, Medicare Supplement plans, or Medicare Advantage plans. hbbe`b``3 1x0@ t I AFP Anthem BCBS of Ohio 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. trailer All Rights Reserved to AMA. note: Exclusions to paying interest may apply based on line of business. We can process the claim after we receive that information. Regence BlueShield - FEP PO Box 1388 Lewiston, ID 83501 Customer Service. 2. . Ting Vit | If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). Contact us for health care providers Contact us for healthcare providers. Featured In: May 2020 Empire Provider News. | Blue Advantage Administrators of Note: Some members will remain in Blue Cross of Northeastern Pennsylvania health plans until their coverage renews to Highmark health plans later this year. Portugus | Phone:800-562-1011Fax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals)Fax: 866-948-8823 (FEP Care Management - prior auth/pre-service requests), Email: CZK Anthem BCBS of Virginia Access eContracting to view and sign agreement documents. AHI BCBS of Rhode Island 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. ABC BCBS of Alabama We haven't received the information. AIJ Empire BCBS Company Description: Regence BlueCross BlueShield of Oregon provides health insurance products and other managed care services to some 750,000 members in Oregon and Washington's Clark County. Coronary Artery Disease. Enter the three digit alphanumeric prefix located on the member's ID card, and the tool provides the correct insurance carrier for you. P.O. BCBS Provider Phone Number. AEG Anthem BCBS of Ohio 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. Deutsch | BCBS Contact Info - Providers, Overseas, and More - FEP Blue Premera Blue Cross Blue Shield of Alaska FEP PO Box 33932 Seattle, WA 98133-0932, Phone:800-562-1011 BCBS Federal Phone Number; Ambetter Claims address and Phone Number; Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit; Kaiser Permanente Phone Number . Lack of credentialing can be grounds for termination from Premeras network. BCBS Prefix List LAA to LZZ - Alpha Lookup by State 2022 CYW Anthem BCBS of Ohio Uprise Health General Access . the claims for which interest payments have been applied during that period.