bcbs prefix list 2021 pdf

BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. For accurate and quick claims processing, it is necessary to get complete patient insurance information. The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. So, to answer this query, we have mentioned below few important points to consider. BCBS member ID have maximum 17 characters but most of the member IDs have 12 characters. 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. 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. 15388 0 obj <>/Encrypt 15364 0 R/Filter/FlateDecode/ID[]/Index[15363 94]/Info 15362 0 R/Length 122/Prev 932133/Root 15365 0 R/Size 15457/Type/XRef/W[1 3 1]>>stream %PDF-1.5 % %%EOF BCBS alpha numeric prefix contains alphabets as well as digits ranging from 1 to 9. PREFIXES . First Care, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). To accommodate our increasing lines of business, Blue Cross and Blue Shield of Montana (BCBSMT) has adopted several new three character prefixes as part of the member identification numbers. endstream endobj startxref Wheelchairs - Mobility Assistive Equipment (Manual & Power) & Scooters - Wheelchair Purchase only -Motorized) Wheelchair: E1050, E1060, E1070, E1083, E1084, E1085 . Medicare Working or retired, we'll help you every step of the way to find the right plan. nKvo2>)*Y=}4i,+s[yL*2#kN@r115};|`R[5/iZ You may also want to know: United Healthcare Claims Address Information. hb``` eaXm.; `Umap@LDPpN jM*,BDu|m_(2*u x y-a`b` #; So, all BCBS plans, including Anthem prefix and Non-Anthem plans announced that member IDs will also be Alpha Numeric from 2018 onwards. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. An incorrect or missing three-character prefix may cause possible delays in the processing of your claims. BCBS Alpha Numeric prefix are three characters at the start of each BCBS insurance member ID. %PDF-1.6 % ?} AN Title: eO\v; tU9kN@]fh:~q:Fye{Q)ihJ HP/VD/_oy\ H ~fa4L?!ekF(\0>o 0 Most Blue Cross Blue Shield (BCBS) member IDs begin with a three-character prefix. BCBS Railroad member IDs starts with a letter R. You may see cards with four-character prefixes, e.g., HMSA Blue Cross Blue Shield of Hawaii uses four-character prefixes. BCBS alpha prefix only contains alphabets and each alpha prefix represents different BCBS home plan. 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. What is the difference between BCBS alpha prefix and BCBS alpha numeric prefix? The three-character prefixes listed do not represent an exhaustive listing of prefixes. This step will help you determine if prior authorization may be required for a specific member and service. 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. BCBS Alpha Prefix List Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. eah xp`}L s1zIq%A9Zc~(Iz~HQu;AT#2$ Wp`Hlpp6NQIV0hg`,g H20[20* ": There are three variants; a typed, drawn or uploaded signature. BCBS alpha numeric prefix digits are usually in between the prefix e.g. BCBS Alpha Numeric Prefix Its a three letter Alpha numeric prefix followed by id number. %%EOF BCBS prefix List plays a vital role in filing the health care claims properly to the correct BCBS address and also to verify members eligibility, health insurance coverage information and to reach the correct BCBS department to check the claim status or disputes of the claim. To identify correct department, they use 3 characters Prefix in the BCBS members plan ID. First Character P is symbolizing that member plan/product type is BCBS PPO. Have a look at our BCBS alpha prefix and BCBS alpha numeric prefix directory below. NBT . A2Z, G2A, J4K etc. In case, you need any additional information related to BCBS prefix then feel free to reach out to us. What If BCBS Member ID doesnt have Prefix mentioned on Card? We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan information. Account Specific Prefix are assigned by BCBS to national accounts. 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. 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. BlueCard. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. BCBS prefix is a three character prefixes followed by the id number except for the following products and programs. BCBS Railroad member IDs are assigned to members who served in railroad organizations. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. endstream endobj startxref To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. Stand-alone dental products, vision and pharmacy when delivered through an intermediary model. Curious to know what are national Accounts? One option is Adobe Reader which has a built-in reader. Let's start with you. I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. 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. It allows you to quickly and easily identify your insurance home plan, saving you time and hassle. 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 By using this directory, you can ensure that you have the most up-to-date information about BCBS home plans and make more informed decisions about choosing right insurance plan. 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. endstream endobj startxref You may also be interested to read about denial code 27 reason and solutions. Address: 11070 Katy Fwy, Houston, TX 77043, 2023 Xceed Billing Solution.com - All Rights Reserved, Blue Cross Blue Shield BCBS Prefix List Lookup. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. 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. Independence Blue Cross* Quick Reference Guide . External link You are leaving this website/app (site). BCBS is one of the biggest insurance companies in USA and serving more than 106 million people. Suite S . BCBS member ID card will have a suitcase logo at the bottom of card which will also help you to identify patient plan like HMO, PPO, POS etc. BCBS Prefix will not only have numbers and the digits 0 and 1. Check any internal documents you may have and update any references of "alpha prefix" to "prefix". CareFirst IDs have plan codes 080/580 and 190/690. for medical policies and prior authorization requests . 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. For Example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU etc. To identify correct blue cross blue shield department, they use three characters BCBS prefix in the start of each BCBS member plan ID. Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. The site may also contain non-Medicare related information. Learn more about timely filing limits and CO 29 Denial Code. Benefits and eligibility should be verified for all members prior to rendering services. 01/01/2021 . 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. 2021, for some of our commercial non-HMO members, such as those listed below: - PPO - Blue Choice Preferred PPO(SM) - Blue Choice PPO(SM) - Blue Options(SM)/Blue Choice Options(SM) - Blue High Performance Network(SM) [Blue HPN(SM)] This is not an exhaustive listing of all codes. BCBS Prefix will not only have numbers and the . Blue Cross Select Silver. BCBS FEP Its indicated with letter R followed by the id number. 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. BCBS National accounts are employer groups that have outlets/offices in multiple states but they offer limited coverage to their employees. "Y24Oz>V ?I L r%dl=vHd z/;/X #k> Gq First Character Z assigned to the BCBS Plan. Not assigned prefix. It clarifies a utilization management vendor change for specific members. Lo-+J52(h' The policy number is usually provided to the policyholder, who is the individual or entity that holds the insurance policy. Baltimore, MD 21237 . 0 There are two types of BCBS prefixes which are mentioned below: Plan Specific prefix are assigned by BCBS to each plan. Prefix ZGP identifies Blue Cross Blue Shield of Texas PPO Product. 'MNiXG]dRBC; 0'Va~9&c}Ag$Pge;\UY,$MtN 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. 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. 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. This new site may be offered by a vendor or an independent third party. The first two characters of such BCBS prefix spots member plan and the third character is to identify the type of product in which the BCBS member is enrolled. 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. BCBS of Illinois (IL) PAK. BCBS Alpha prefix lookup contains all the Blue Cross Blue Shield alpha prefix along with their home plan and website. Have a look at our BCBS alpha prefix and BCBS alpha numeric prefix directory below. Coverage For: Individual + Family. Member ID cards with no prefix Some member ID cards may not have a prefix. 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 . We have a track record of providing quality medical billing services to multiple healthcare organizations and specialty providers across USA. This new site may be offered by a vendor or an independent third party. Call 1-800-388-3193 . Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Complete patient information, on the other hand, allows your claims to process without delays. Please DO NOT randomly select a three-character prefix. Prefix UTS assigned to University of Texas. BCBS Alpha Prefix Its a three letter alpha prefix followed by id number. If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance. Commercial Communications Blue Shield (BS) of California. 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. BCBS Alpha Numeric Prefix - It's a three letter Alpha numeric prefix followed by id number. Due to the exceeding number of BCBS insurance members, Alpha-Only Prefix member IDs exhausted. By doing it may cause delay in processing or handling the claim. For providers and medical billers who are performing medical billing services, BCBS alpha prefix are helpful to identify the correct payer ID and address for claims submission. BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. BCBS Prefix List 2021 - Alpha State Lookup BCBS Company; AAA: Alabama: Blue-Cross Blue-Shield of Alabama: AAB: Michigan: Blue-Cross Blue-Shield of Michigan: AAC: Illinois: Blue-Cross Blue-Shield of Illinois: AAD: South Carolina: Blue-Cross Blue-Shield of South Carolina: AAE: Nevada: 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$M'JL+0?\:3Y(+Sb1:_%^uur(h>mS Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). What is Medical Billing and Medical Billing process steps in USA? 761 0 obj <>/Filter/FlateDecode/ID[]/Index[741 37]/Info 740 0 R/Length 98/Prev 110535/Root 742 0 R/Size 778/Type/XRef/W[1 2 1]>>stream TT$%b"Dg!h^`]-ce?i8xRiu1IrD-%oR#yt;JBOJ#"TXwD0L Fw,]xS_CU3zf]06_T} PNGCqWV^UET6X~`U The prefix routes eligibility/benefits inquiries and claims to the appropriate BCBS Plan or system for timely processing. TPA Name & Address. All prefixes are unique. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. In that case claim may be denied as Submit the claim to the correct address / Member ID not found. 8772287268 Mail Administrator P.O. %%EOF So the next time you need to identify accurate BCBS prefix home plan, remember to use the BCBS prefix list lookup finder. Carefirst BCBS of Maryland the (MD), District of Columbia (DC) and the Northern Virginia (VA) Benefits Administration Corporation, Inc. (BACI) 9411 Philadelphia RD. 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. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 0|kEMi_a*-Yfj#uqEcA/6 .M.6YNw4cyo>lESMC\)H~L 1B> BCBS is one of the largest medical insurance company by total members of more than 45 million. For example: A2A12345678 Here " A2A" is BCBS alpha numeric prefix. BCBS Alpha prefix are the three characters at the start of each BCBS insurance member ID. These prefixes may include alpha and numerical characters. We make sure to update the information on daily basis, however, if you find some kind of inaccurate information, feel free to contact us. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. In some case provider or billing company may file the claim to an incorrect address without checking the correct BCBS address. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. To view this file, you may need to install a PDF reader program. Box 7930 Philadelphia, PA 19101-7930 Last updated: 07/01/2022. PAGE : Amkor Technology, Inc. Group # 039176 : AmeriBen . Normally, account specific prefix associates to the employer group name. We offer a wide choice of individual plans to fit your health needs and budget. For Example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU etc. These BCBS prefix may include alpha and numerical characters. 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. %{!]/Ox^ A[BXe S#(Df Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. 0 Contact us to learn how we can improve your revenue cycle. Our Health Choice plans are available to Arizonans who qualify for Medicaid. `xn_F-y(MQ&O!y1?-uZ=t'=E$r2$IA)gYWp&g` These plans provide health insurance coverage for railroad employees, retirees, and their eligible dependents. The site may also contain non-Medicare related information. by calling 1-844-377-1278 (BCN) or 1-800-728-8008 (Blue Cross) or by logging oncology and in to the AIM ProviderPortal. Working or retired, we'll help you every step of the way to find the right plan. The prefix may also route claim status inquiries and remit searches. We always make sure to keep BCBS prefix list and BCBS provider phone numbers directory up to date. BCBS prefix lookup directory is a valuable resource for anyone who is looking for right Blue Cross Blue Shield home plan. 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. Box 14115 Lexington, KY 40512 Mail Administrator P.O. PPO 837P Prefixes are also applicable, . If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. The prior authorization information in this notice does not apply to requests for HMO members. endstream endobj 366 0 obj <>>>/Filter/Standard/Length 128/O(`iYJhD[>R`Xq)/P -1324/R 4/StmF/StdCF/StrF/StdCF/U(ETWBQcf )/V 4>> endobj 367 0 obj <>/Metadata 16 0 R/PageLayout/OneColumn/Pages 363 0 R/StructTreeRoot 28 0 R/Type/Catalog>> endobj 368 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 369 0 obj <>stream You can also contact us for specialty medical billing services. We make it easy for you to offer the healthcare coverage that delivers for your business. endstream endobj 1230 0 obj <. e@'SZD/KCbv*pKq~ 741 0 obj <> endobj We have the right plan for you to keep you and your family covered. How To Identify Blue Cross Blue Shield Member? Box 14114 Lexington, KY 40512 Federal Employee Program (FEP) R prefix DC/Metropolitan Area 2024884900 MD 8008545256 DC/Metropolitan Area Mail Administrator P.O . 15363 0 obj <> endobj Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. 404 0 obj <>stream hbbd```b``A$ Some members ID cards may not have an alpha prefix. BCBS Alpha Prefix are not only important to identify BCBS health insurance member but they are also very important for electronic submission of claims to the correct BCBS plan. Prefix Group Address Group Name TPA Name & Address Claims Filing Claims & Benefit Contact Name Phone . 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. Availity provides administrative services to BCBSIL. Follow the step-by-step instructions below to design your premiere blue cross amp the regency group three character prefixes: Select the document you want to sign and click Upload. 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. 1229 0 obj <> endobj Plan Type: PPO . Why does BCBSAZ update member accounts and . We recently received a query from a provider that how I can identify that patient is BCBS health insurance member. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. 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& One option is Adobe Reader which has a built-in reader. Commercial Prior Authorization Summary and Code Lists Policy number is a unique number, which is provided to their insured person by respective insurances in order for identification purposes and also for billing the healthcare claims. Independence Blue Cross (BC) of Philadelphia (Phi) and the Southeastern Pennsylvania (PA) PAI. claims_and_billing/edi/ibc_ professional_payer_id.pdf 54704 -SX083 837I -12X26 Claims Address Claims Receipt Center Box 211184 Eagan, MN 55121 Adjustment Claims Inquiries P.O.

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