hb``` eaXm.; `Umap@LDPpN jM*,BDu|m_(2*u x y-a`b` #; For Example: XYZ123456789. See the Medical oncology prior authorization list for Blue Cross and BCN commercial members for a supportive care drugs (other than CAR -T comprehensivelist of managed by AIM, and groupsincluded in the program. Xceed Billing Solutions motive is to create ease for providers, medical billers, patients and everyone who is involved in revenue cycle process. The policy number is a unique identifier which may cover multiple members under the same policy, such as a family or a group. You may also be interested to read about denial code 27 reason and solutions. %%EOF 777 0 obj <>stream We always make sure to keep BCBS prefix list and BCBS provider phone numbers directory up to date. endstream endobj startxref It means that BCBS members IDs prefixes will must have alphabets. It means that BCBS members IDs prefix will must have alphabets and they may or may not have numbers. Suppose assume claims filed with an incorrect member ID number or BCBS prefix by Provider or Billing companies, then BCBS insurance will deny the claim stating Incorrect member ID, please submit with an correct member ID number. 761 0 obj <>/Filter/FlateDecode/ID[]/Index[741 37]/Info 740 0 R/Length 98/Prev 110535/Root 742 0 R/Size 778/Type/XRef/W[1 2 1]>>stream These prefixes may include alpha and numerical characters. The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications One option is Adobe Reader which has a built-in reader. BCBS Railroad member IDs are assigned to members who served in railroad organizations. This can be especially helpful if youre in a rush or need to access your BCBS prefix home plan information quickly. Lo-+J52(h' PREFIXES . First Character Z assigned to the BCBS Plan. CareFirst IDs have plan codes 080/580 and 190/690. Although we regularly update the BCBS Prefix information but in case youre unable to get information about correct BCBS plan from our BCBS Prefix lookup, feel free to contact us OR call BCBS directory phone number at 800-676-2583. Correct BCBS home plan can easily be identified using our BCBS prefix lookup directory. 1268 0 obj <>stream The SBC shows you how you and the plan would share t. he cost for covered health care services. BCBS Alpha Prefix are first three letters of BCBS Member ID to identify correct Blue Cross Blue Shield department responsible for managing the patient eligibility, benefits and claims etc. 15363 0 obj <> endobj ?} AN Services that require precertification As of January 1, 2022, this list applies to all Independence Blue Cross HMO, PPO, and POS products, including Flex products. Some members ID cards may not have an alpha prefix. Now, with more than 15 years of experience as a medical biller and revenue cycle manager, I am on a mission to serve the medical billing industry with my vast knowledge and years of expertise. Also, these BCBS prefixes helps providers and medical billers to reach the correct claims department for claims and benefits inquiry. Curious to know what are national Accounts? BCBS alpha numeric prefix contains alphabets as well as digits ranging from 1 to 9. BCBS Alpha Prefix list is useful for both providers and BCBS enrolled members/patients. Note for Front Desk and Providers: When Blue Cross Blue Shield members comes to your facility or office, make sure to ask them for their active BCBS plan member ID card. BCBS Alpha Prefix List The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. Please look for instructions or a phone number on the back of the member ID card. Most PDF readers are a free download. Here Letter R indicates BCBS FEP prefix. What is a member ID prefix? Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Box 14114 Lexington, KY 40512 Federal Employee Program (FEP) R prefix DC/Metropolitan Area 2024884900 MD 8008545256 DC/Metropolitan Area Mail Administrator P.O . If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance. For Federal Employee Program (FEP) precertification requirements, please see the separate FEP precertification list. Northwest Arizona Employee Benefit Trust (NAEBT) Group # 037461 . Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. This includes our Medicaid Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM(MA PPO) members. Commercial Prior Authorization Summary and Code Lists For example: A2A12345678 Here " A2A" is BCBS alpha numeric prefix. Box 805107, Chicago, Illinois 60680-4112. Current prefixes will still be valid once the new alpha-numeric prefixes are issued, unless there is another need to change or remove a prefix . BCBS alpha numeric prefix digits are usually in between the prefix e.g. Independence Blue Cross (BC) of Philadelphia (Phi) and the Southeastern Pennsylvania (PA) PAI. Prior Authorization Services For Fully Insured and ASO, Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO), Prior Authorizations Lists for Designated Groups, Prior Authorization Exemptions (Texas House Bill 3459), Medicare Advantage Private Fee-for-Service (PFFS), Eligibility and Benefits Inquiry (HIPAA 270/271), Behavioral Health Care Management Program, Quality Care Partner With Your Patients, Preventive Care Guidelines/Patient Wellness Guidelines, Health Equity and Social Determinants of Health (SDoH), Prescription Drug List and Prescribing Guidelines, Prior Authorization and Step Therapy Programs, Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members, Consolidated Appropriations Act and Transparency in Coverage Final Rule, Blue Cross Blue Shield of Texas provider website. 1 of 7. B}hJu`n+Z9>)2B~feo,TV [ZI^ylRr8DGo;ckrA;X2SjUlW]$4_vN(Tvh6#moc0!pbJ;oW)A'oR&bH=`1K}P(u3gD9:#1!m2saW1SD5/p2 'Su &x@`N.e#U(Fne]4;$"o*k;$~gn-Sd"mjdTY2R*I:w8w3;fpCfQH& Commercial Communications eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. BCBS Alpha prefix lookup contains all the Blue Cross Blue Shield alpha prefix along with their home plan and website. Save my name, email, and website in this browser for the next time I comment. Have a look at our BCBS alpha prefix and BCBS alpha numeric prefix directory below. Always make sure to submit claims to insurance company on time to avoid timely filing denial. To identify correct blue cross blue shield department, they use three characters BCBS prefix in the start of each BCBS member plan ID. For example: ABC12345678 Here " ABC" is BCBS alpha prefix. All prefixes are unique. In some case provider or billing company may file the claim to an incorrect address without checking the correct BCBS address. We offer a wide choice of individual plans to fit your health needs and budget. BCBS Prefix will not only have numbers and the digits 0 and 1. To identify correct department, they use 3 characters Prefix in the BCBS members plan ID. endstream endobj startxref e@'SZD/KCbv*pKq~ Does policy number same as member ID number? Learn more about timely filing limits and CO 29 Denial Code. To view this file, you may need to install a PDF reader program. Blue Cross Select Silver. PPO 837P Prefixes are also applicable, . These BCBS prefix may include alpha and numerical characters. We have a track record of providing quality medical billing services to multiple healthcare organizations and specialty providers across USA. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. eO\v; tU9kN@]fh:~q:Fye{Q)ihJ HP/VD/_oy\ H ~fa4L?!ekF(\0>o So the next time you need to identify accurate BCBS prefix home plan, remember to use the BCBS prefix list lookup finder. Please look for claim filing instructions on the back of the ID card. Group Name. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. %%EOF Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). If youre 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. Customer Service: 1-800-409-9462 HCSC-PORT. There are three variants; a typed, drawn or uploaded signature. BCBS Prefix should be included along with ID number, exactly as it appears on the member ID card when filing the claims to insurance company. View Medicare information Radiology utilization for Arkansas Blue Cross FEP hbbd``b`f3$ bE FM Dmb"@ $$@z$u ad#B cG We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. It clarifies a utilization management vendor change for specific members. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. We offers a wide range of RCM solutions to improve your healthcare services financial health and allows you to focus on patients care rather than collecting payments from insurances and patients for services performed. Prior Authorization for Some Commercial Members Will Transition from eviCore to AIM, Effective Jan. 1, 2021 This notice was posted Oct. 1, 2020, to alert you of a utilization management vendor change. Make sure to make copies of the front and back of member ID card. Carefirst BCBS of Maryland the (MD), District of Columbia (DC) and the Northern Virginia (VA) BlueCard. Correct BCBS home plan can easily be identified using our BCBS prefix lookup directory. And to manage such a big network, they divided it into different departments state wise or employer specific. 01/01/2021 . Blue Cross and Blue Shield of Illinois, P.O. To run such a large number of people, they divided Blue Cross Blue Shield Insurance Association into different departments which is employer specific or state wise. `xn_F-y(MQ&O!y1?-uZ=t'=E$r2$IA)gYWp&g` Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. Why does BCBSAZ update member accounts and . Additionally, the following services require Prior Authorization regardless of place of service or level of care: To submit a prior authorization request you may also fax or mail your request. Benefits and eligibility should be verified for all members prior to rendering services. By doing it may cause delay in processing or handling the claim. Note: BCBS FEP (Federal Employee Program) ID starts with the alphabet R follow by the insured ID number (For Example: R987654321). hbbd```b``"`r9LLN`DR,>6l30&U$60D2HO rH+H f`bdV8J BCBS Prefix AAA Home Plan and Phone Number, BCBS Alpha Numeric Prefix from Y2A to Y9Z, BCBS Alpha Numeric Prefix from X2A to X9Z, BCBS Alpha Numeric Prefix from W2A to W9Z, BCBS Alpha Numeric Prefix from V2A to V9Z, Frequently Asked Questions Related to BCBS Prefix. BCBS Alpha Numeric Prefix - It's a three letter Alpha numeric prefix followed by id number. BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. There are two types of BCBS prefixes which are mentioned below: Plan Specific prefix are assigned by BCBS to each plan. Please DO NOT randomly select a three-character prefix. Second Character G assigned to the BCBS Plan as well. Normally, account specific prefix associates to the employer group name. The BCBS prefix lookup directory is regularly updated with the latest BCBS insurance plan information, so you can be sure that the information youre viewing is 100% accurate. NBT . First, it saves you time and hassle by allowing you to quickly identify correct BCBS insurance home plan without having to call customer service. Born in Texas, USA. Lets dig into it! The most important and easy way to identify BCBS member is his BCBS member ID alpha prefix. 0 Prefix ZGP identifies Blue Cross Blue Shield of Texas PPO Product. hb```I! Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. The three-character prefix at the beginning of the members identification number is the key element used to identify and correctly route out-of-state claims to the appropriate BCBS Plan. BCBS Railroad member IDs starts with a letter R. Not assigned prefix. Title: The three-character prefix at the beginning of the member's identification number is the key element used to identify and correctly route out-of-state claims to the appropriate BCBS Plan. The three-character prefixes listed do not represent an exhaustive listing of prefixes. Stand-alone dental products, vision and pharmacy when delivered through an intermediary model. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. Final Remarks about BCBS Prefix Lookup Directory. If you have any questions, call the number on the members ID card. $=0j]xkM#[f4YgI|in Z(0zF1-9gk!D @WeUUn/R%$'c|J6:z}\}8ZNd+SL5-h"\wE$w{3\zO>,Vta$a`D7rHmr$bwZm7yYO)&^E<2@9#&UDOz hbbd```b``A$ First Character P is symbolizing that member plan/product type is BCBS PPO. Prefix Group Address Group Name TPA Name & Address Claims Filing Claims & Benefit Contact Name Phone . BCBS Prefix List 2021 - Alpha Numeric State Lookup BCBS Company; Z2A-Prefix Unallocated/Not Assigned: Z2B: Indiana: Anthem Blue-Cross Blue-Shield of Indiana: Z2C-Prefix Unallocated/Not Assigned: Z2D-Prefix Unallocated/Not Assigned: Z2E-Prefix Unallocated/Not Assigned: Z2F: Minnesota: You may also want to know: United Healthcare Claims Address Information. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. For more information, contact your Network Provider Consultant or call 406-437-6100. Medicare Working or retired, we'll help you every step of the way to find the right plan. Working or retired, we'll help you every step of the way to find the right plan. q8-_?UT"X e+1?#7DMKHY]?R,-e;PE\mL Wheelchairs - Mobility Assistive Equipment (Manual & Power) & Scooters - Wheelchair Purchase only -Motorized) Wheelchair: E1050, E1060, E1070, E1083, E1084, E1085 . BCBS prefix is a three character prefixes followed by the id number except for the following products and programs. We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan information. bcbs prefix list PDF,Doc ,Images [PDF] Common Prefix Portal List PBC Premera Blue Cross Three Character Prefixes. What If BCBS Member ID doesnt have Prefix mentioned on Card? Each BCBS alpha numeric prefix represents different BCBS home plan. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Xceed Billing Solutions is amedical billing company for outsourcing medical billing services. "Y24Oz>V ?I L r%dl=vHd z/;/X #k> Gq The site may also contain non-Medicare related information. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Coverage For: Individual + Family. The policy number is usually provided to the policyholder, who is the individual or entity that holds the insurance policy. Below in our BCBS prefix lookup directory, you can lookup all the BCBS prefix appropriate home plans and their contact information. Narrow Network: Provider participation is by invitation. Call 1-800-388-3193 . Three-Character Prefixes. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing, Empire Blue-Cross Blue-Shield of New York, Anthem Blue-Cross Blue-Shield of Kentucky, Maryland/District of Columbia/Northern Virginia, Highmark Blue-Cross Blue-Shield of Pennsylvania, Anthem Blue-Cross Blue-Shield of Connecticut, Anthem Blue-Cross Blue-Shield of Colorado, Anthem Blue-Cross Blue-Shield of New Hampshire, Anthem Blue-Cross Blue-Shield of Missouri, Blue-Cross Blue-Shield of Western New York, Independence Blue-Cross of Philadelphia and Southeastern Pennsylvania, Anthem Blue-Cross Blue-Shield of Virginia, Excellus Blue-Cross Blue-Shield of New York, Anthem Blue-Cross Blue-Shield of Wisconsin, Highmark Blue-Cross Blue-Shield of West Virginia, Horizon Blue-Cross Blue-Shield of New Jersey, Highmark Blue-Cross Blue-Shield of Delaware. There are several benefits of using our BCBS Prefix Lookup tool. We have the right plan for you to keep you and your family covered. Prior Authorization List for Blue Shield Effective April 1, 2023 (This list is updated monthly) blueshieldca.com 601 12th Street | Oakland, CA 94607 Blue Shield of California is an independent member of the Blue Shield Association April 1, 2023 Page 1 of 8 Policy Name/Program Procedure Code (To search, press Ctrl + F) . Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Search for doctors near you and in your network. O}BAXv:OP)Qt9>PN,RG4uZu~?raYW+Q`|w[OD klW1Kg|'6'8=rRW00+,oD~`Ox(4DLMm,$Uy69r!$w0.<5>gJd'0?wf\2t| :\xQ cwh)}Ycb8I5vg~TQNnx^Y$M'JL+0?\:3Y(+Sb1:_%^uur(h>mS The prefix may also route claim status inquiries and remit searches. ", Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). DIGNITY HEALTH YAVAPAI REGIONAL MEDICAL CENTER AND BLUE CROSS BLUE SHIELD OF ARIZONA REACH AGREEMENT, FIESTA BOWL AND BLUE CROSS BLUE SHIELD OF ARIZONA OPEN APPLICATIONS FOR FOURTH ANNUAL EMPOWERING DIVERSITY SCHOLARSHIP, PCMH PROGRAM DELIVERS HEALTHIER PATIENTS AND HAPPIER PROVIDERS. Summaries and code lists are posted as a reference to help you determine when prior authorization may be required for non-HMO government programs members. Also, pre-authorization information and medical policy for out of state plans may be found on the Blue Cross Blue Shield of Texas provider website section under Standards and Requirements, and then select "Medical Policy and Precertification/Preauthorization for Out of Area Members. The prior authorization information in this notice does not apply to requests for HMO members. Individuals & Families We offer a wide choice of individual plans to fit your health needs and budget. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. eah xp`}L s1zIq%A9Zc~(Iz~HQu;AT#2$ Wp`Hlpp6NQIV0hg`,g H20[20* ": You may see cards with four-character prefixes, e.g., HMSA Blue Cross Blue Shield of Hawaii uses four-character prefixes. It shows that these type of BCBS member IDs are different. endstream endobj 15364 0 obj <>>>/EncryptMetadata false/Filter/Standard/Length 128/O(a;uY[7y\\ Y)/P -1036/R 4/StmF/StdCF/StrF/StdCF/U(ZgYX: )/V 4>> endobj 15365 0 obj <>/Metadata 280 0 R/PageLayout/OneColumn/Pages 15351 0 R/StructTreeRoot 2939 0 R/Type/Catalog>> endobj 15366 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 15367 0 obj <>stream The main difference between BCBS alpha prefix and BCBS alpha numeric prefix is that BCBS alpha prefix only contains alphabets whereas BCBS alpha numeric prefix consists of alphabets as well as numbers ranging from 1 to 9. These plans provide health insurance coverage for railroad employees, retirees, and their eligible dependents. Denials with solutions in Medical Billing, Denials Management Causes of denials and solution in medical billing, CO 4 Denial Code The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code The Procedure/revenue code is inconsistent with the patients age, CO 7 Denial Code The Procedure/revenue code is inconsistent with the patients gender, CO 15 Denial Code The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code This is a work-related injury/illness and thus the liability of the Workers Compensation Carrier, CO 23 Denial Code The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code Benefit maximum for this time period or occurrence has been reached or exhausted, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Anthem Blue Cross Blue Shield Timely filing limit BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States. The purpose of this list is to assist WA and AK providers to determine plan [PDF] CareFirst Third Party Administrator (TPA)/Network Lease Accounts Prefix. Use this guide to see prior approval information for members with ID card prefixes: AEE, AXC, EXX, XCB, XCQ, XCR View guides [pdf] Medicare plans Learn more about providing care for Medicare members. No, the BCBS policy number is not typically the same as the BCBS member ID number. Does BCBS Cover Wegovy for Weight Loss? To identify the plan that holds the members benefits, please call the Out-of-State Blues Plan Subscriber #: 1-800-676-BLUE (2583). In that case claim may be denied as Submit the claim to the correct address / Member ID not found. In order to get rid of this denial or sometimes delay in processing, Provider or Billing companies has to find out the correct address by BCBS prefix from the above list before filing the claim. Note: Current three-character, alpha-only prefixes will not be affected by this change. endstream endobj startxref Complete patient information, on the other hand, allows your claims to process without delays.