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. Coding toolkit View our clinical edits and model claims editing. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. To obtain a UMP document in another format (such as Braille or audio), call UMP Customer Service. Claims and clinical appeals address: PO Box 21702 Eagan, MN 55121 Care management Phone: 844-996-0329 Fax: 888-302-9325 2023 holiday closures January 2 May 29 July 4 September 4 November 23 November 24 December 25 UMP Customer ServicePhone: 1 (888) 849-3681 TRS: 711 Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)Chat Live: Sign in to your Regence account Monday through Friday 7 a.m. to 5 p.m. (Pacific) to access chat live. Find helpful phone, fax and email information for assistance. Claims & payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. 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. hbbe`b``3 1x0@ t I Coordination of Benefits (COB) is a provision included in both member and physician and provider contracts. We also apply the following Prompt Pay standards set by the Oregon Insurance Division to our claims adjudication process in order to: A clean claim is one that has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payments from being made on the claim. As a KingCare member, your care is covered at a higher level inside the network, but the plan also pays a smaller amount toward your bill if you see a doctor outside of the KingCare PPO network. Blue Cross and Blue Shield of Illinois P.O. %PDF-1.4 % AGX Anthem BCBS of Virginia 0000018992 00000 n CVV Anthem Blue Cross of California AFG BCBS of Nebraska All Blue Plans replaced Social Security numbers on member ID cards with an alternate, unique identifier. TINs are still a required element for claims. ADT BCBS Minnesota BCBS Prefix List PAA to PZZ - Alpha Lookup by State 2022 Invalid claims are reported back to the provider with rejection details. QMB SG ON Exchange ABJ BCBS Minnesota CNK-HR-0230 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. ABR Carefirst BCBS Maryland We are now processing credentialing applications submitted on or before March 14, 2023. CZZ Highmark BCBS You have to avoid this idea when you have geared up for successfully using the health insurance plan. 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. 1-800-423-1973. Eligibility, enrollment, and address/name changes. Interested in joining our provider network? AIE BCBS of Michigan If we receive the complaint before the 365-day deadline, we review and issue a decision within 30 calendar days via letter or revised Explanation of Payment. ), Number assigned to the claim when received by plan. Fax: 801-333-6523 (Mark claims: Attn New Claims) Email: Log in or register - MyBlue Customer eService. If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). 0000001762 00000 n We regularly update (at least quarterly) our claims editors to keep pace with changes in medical technology, as well as CPT codes, HCPCS codes, and ICD-10-CM/PCS Diagnosis and Procedure code changes, standards, and complexities. Regence Blue-Cross Blue-Shield: PDS: Maryland/District of Columbia/Northern Virginia: Carefirst Blue-Cross Blue-Shield: PDT: Pennsylvania: Tagalog | 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). Please refer to the members ID card to determine if he/she has one of these products. The charges for this service have been combined into the primary procedure based on the provider's contract. 1-800-962-2731. PO Box 52080 CZJ Premera Blue Cross of Washington Practitioners who arent credentialed may have their claims returned until they submit a complete credentialing application. Boise, ID 83707. If you get the plan specific alpha prefix, then the first two characters in this prefix are used to identify your plan. An interest check is issued only for months in which the accumulated interest is equal to or greater than the minimum threshold of $25. 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. Because your primary doctor and your specialists may all work for different clinics, you may need to do more of your own care coordination. 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. CVY BCBS of Louisiana Tel: 877-668-4651. AHC Anthem BCBS of Missouri ABN Anthem BCBS of Virginia LAB. Attach a completed Corrected Claim - Standard Cover Sheet.. Kreyl Ayisyen | 0000004968 00000 n Do not make up alpha prefixes or assume that the members ID number is the Social Security Number. A required waiting period must pass before we can provide benefits for this service. Pension & Retirement. You can submit a complaint about one of our actions (verbally or in writing) to one of our employees. To help your office complete year-end accounting, each December we'll issue you a check for the accrued interest we owe you, even if the amount is below the COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. When this notification has occurred, change the indicator on your claims from (. Enter a ZIP code in that box. 398-0520-PN-NY. Refund total overpayment amounts within 60 days of initial notice to avoid having outstanding refund amounts offset against future payments. If you are unable to submit claims electronically, you can submit paper claims on CMS-1500 or UB-04 forms. Kreyl Ayisyen | When dependent children are double-covered by divorced parents, coverage depends on any court decrees. To contact Corporate, please call 1-425-462-1000 Monday - Friday 8:00 AM to 5:00 PM PT. 1 (877) 878-2273 Contact Us. Generally, if the court decrees financial responsibility for the child's healthcare to one parent, that parent's health plan always pays first. CZM Highmark BCBS To do so, please submit the proposal in writing to your assigned Provider Network Executive (PNE) or Provider Network Associate (PNA). national customer service numbers at fepblue.org, Espaol | xref Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Please follow Were ready. 2023 Regence BlueShield. AGE Independence Blue Cross Your member ID card is your key to using your medical plan benefits. CVS Caremark. The 2015 member identification prefixes for individual Medicare Advantage plans are listed below. Regence Blue-Cross Blue-Shield: YAM-Unallocated/Not Assigned: YAN-Unallocated/Not Assigned: YAO-Unallocated/Not Assigned: YAP: Minnesota: Home | Northwest Carpenters Trusts Receiving payment Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. PDF Electronic Remittance Advice Enrollment - Availity Physicians and other healthcare providers receive an Explanation of Payment (EOP), which describes our determination of the payment for services. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. AEJ Horizon BCBS of New Jersey You could download the full BCBS prefixes list is here. ACS BCBS of IL View your credentialing status in Payer Spaces on Availity Essentials. Once you have signed in, simply click on the Authorizations on the top menu and you will be able to submit your preauthorization request. Also its not a sequential order hence its hard to find unless we check with first 3 alpha prefix. Italiano | The protection of your privacy will be governed by the privacy policy of that site. 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). CVC Anthem BCBS of Ohio Regence Blue Shield of Idaho - FEPPO Box 30270Salt Lake City, UT 84131-0207. Be on . ** PPO in a suitcase logo, for eligible PPO members Blue-Cross Blue-Shield of Tennessee. The provider needs to submit itemized charges to us. 0000010898 00000 n The time period does not start until we receive a complete appeal. Payment of this claim depended on our review of information from the provider. We can process the claim after we receive that information. CWE BCBS of Michigan Colorado. Ideally, we'd like you to submit claims within 60 calendar days of the covered services, but no later than 365 calendar days from the date of submission. Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. Employees:Contact your payroll or benefits office. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. The Level I Appeal must be submitted within 365-days following the action that prompted the dispute. AEK Independence Blue Cross Our process meets or exceeds the requirements set by the Office of the Insurance Commissioner. YDZ SG OFF Exchange However we have some guide to follow, using prefixes we could find the state of the BCBS and contact phone number to proceed further. As members renew or enroll their individual or group contracts for health care coverage in 2016, they will be presented with a new Highmark branded ID card. Claims & payment - Asuris Chronic Obstructive Pulmonary Disease. Modifiers. AGH Anthem Blue Cross of California ACX BCBS of IL Claims. Box 31 Enter the physician or providers name that performed the service. Asthma. ARH IN BCBS of Indiana, POB 68416, Accordia NW , Indianapolis , IN , 46268 317-488-6000, ARR OH BC OH Anthem, 4361 Irwin Simpson Rd , Mason , OH , 45040 513-872-8100, ASA Indemnity CNY PO Box 4809 , Syracuse , NY , 13221 315-448-3735, ASH WNY BCBS WNY, Auto Natl Accts, POB 757 , Buffalo , NY , 14240-0757 800-462-7237, AST TN BCBS Of Tennessee, 801 Pine St , Chattanooga , TN , 37402 423-755-5600, ATT Empire Empire BC, POB 5020 , Middletown , NY , 10940 800-772-2875, AWR PA PA BS Highmark, POB 535045 , Pittsburgh , PA , 15253-5045 800-294-2217, AZO IL BC IL, POB 1364 , Chicago , IL , 60690-1364 800-637-6917, BAN WV BC Washington DC/Carefirst, 550 12th St SW , Washington , DC , 20065 800-642-2411, BBH PPO GA BCBS GA, POB 9907 , Columbus , GA , 31908 800-628-3988, BDC MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237 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.