Search for doctors near you and in your network. 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. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. bcbs prefix list PDF,Doc ,Images [PDF] Common Prefix Portal List PBC Premera Blue Cross Three Character Prefixes. To identify correct department, they use 3 characters Prefix in the BCBS members plan ID. BCBS prefix lookup directory is a valuable resource for anyone who is looking for right Blue Cross Blue Shield home plan. Carefirst BCBS of Maryland the (MD), District of Columbia (DC) and the Northern Virginia (VA) The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. 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. 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 $=0j]xkM#[f4YgI|in Z(0zF1-9gk!D @WeUUn/R%$'c|J6:z}\}8ZNd+SL5-h"\wE$w{3\zO>,Vta$a`D7rHmr$bwZm7yYO)&^E<2@9#&UDOz To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. It shows that these type of BCBS member IDs are different. hbbd```b``@$Df/i #D2lE``vd@ "@,iZ R R2H{v# k This new site may be offered by a vendor or an independent third party. hbbd``b`f3$ bE FM Dmb"@ $$@z$u ad#B cG Box 7930 Philadelphia, PA 19101-7930 To identify correct blue cross blue shield department, they use three characters BCBS prefix in the start of each BCBS member plan ID. One option is Adobe Reader which has a built-in reader. What is a member ID prefix? The most important and easy way to identify BCBS member is his BCBS member ID alpha prefix. Contact us to learn how we can improve your revenue cycle. 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. K8Z : Page 2 . Save my name, email, and website in this browser for the next time I comment. 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 . (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.). What If BCBS Member ID doesnt have Prefix mentioned on Card? This step will help you determine if prior authorization may be required for a specific member and service. For Example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU etc. 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. Independence Blue Cross (BC) of Philadelphia (Phi) and the Southeastern Pennsylvania (PA) PAI. Each BCBS alpha numeric prefix represents different BCBS home plan. Lo-+J52(h' Benefits Administration Corporation, Inc. (BACI) 9411 Philadelphia RD. PDF Updated November 2021 - BCBSIL Medicaid Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. ). Please look for claim filing instructions on the back of the ID card. There are two types of BCBS prefixes which are mentioned below: Plan Specific prefix are assigned by BCBS to each plan. PPO 837P Prefixes are also applicable, . First, it saves you time and hassle by allowing you to quickly identify correct BCBS insurance home plan without having to call customer service. Most PDF readers are a free download. 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 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. 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& Box 14114 Lexington, KY 40512 Federal Employee Program (FEP) R prefix DC/Metropolitan Area 2024884900 MD 8008545256 DC/Metropolitan Area Mail Administrator P.O . 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. NBT . 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. TPA Name & Address. 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. These BCBS prefix may include alpha and numerical characters. 777 0 obj <>stream Three-Character Prefixes. BCBS Alpha Numeric Prefix Its a three letter Alpha numeric prefix followed by id number. Blue Shield (BS) of California. BCBS Alpha Prefix Lookup 2023 BCBS Alpha Prefix Its a three letter alpha prefix followed by id number. Availity provides administrative services to BCBSIL. The prefix routes eligibility/benefits inquiries and claims to the appropriate BCBS Plan or system for timely processing. Member identification numbers beginning with R belong to Federal Employee Program (FEP) and will not have a three-character prefix when filing. For accurate and quick claims processing, it is necessary to get complete patient insurance information. Does policy number same as member ID number? 0 PDF BCBSAZ/TPA Co-Administered Group Plans - AZBlue For more information, contact your Network Provider Consultant or call 406-437-6100. BCBS member ID have maximum 17 characters but most of the member IDs have 12 characters. Account Specific Prefix are assigned by BCBS to national accounts. plan. An incorrect or missing three-character prefix may cause possible delays in the processing of your claims. Title: BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. Blue Cross Select Silver. A2Z, G2A, J4K etc. What is Medical Billing and Medical Billing process steps in USA? Stand-alone dental products, vision and pharmacy when delivered through an intermediary model. 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. What is Medical Billing and Medical Billing process steps in USA? We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan 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. Make sure to make copies of the front and back of member ID card. 'MNiXG]dRBC; 0'Va~9&c}Ag$Pge;\UY,$MtN T. he Summary of Benefits and Coverage (SBC) document will help you choose a health. Last updated: 07/01/2022. eO\v; tU9kN@]fh:~q:Fye{Q)ihJ HP/VD/_oy\ H ~fa4L?!ekF(\0>o BCBS Prefix will not only have numbers and the digits 0 and 1. BCBS Alpha Numeric Prefix - It's a three letter Alpha numeric prefix followed by id number. 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. These BCBS prefix may include alpha and numerical characters. View Medicare information Radiology utilization for Arkansas Blue Cross FEP 2021 Commercial Prior Authorization Requirements Summary (Updated December 2020) This document provides an overview of services/care categories for which prior authorization may be required for some commercial, non-HMO Blue Cross and Blue Shield of Illinois (BCBSIL) members. 800-676-2583. 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. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. endstream endobj startxref BCBS alpha prefix only contains alphabets and each alpha prefix represents different BCBS home plan. PDF Provider Quick Reference Guide - CareFirst 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. BCBS Alpha Prefix List For Federal Employee Program (FEP) precertification requirements, please see the separate FEP precertification list. Does BCBS Cover Wegovy for Weight Loss? BCBS alpha numeric prefix contains alphabets as well as digits ranging from 1 to 9. Check any internal documents you may have and update any references of "alpha prefix" to "prefix". In addition, some sites may require you to agree to their terms of use and privacy policy. endstream endobj 742 0 obj <. Customer Service: 1-800-409-9462 HCSC-PORT. PREFIXES . BCBS Prefix List - Alpha Lookup by State 2022 - Finder So, to accomplish our goal, we have listed down the complete BCBS alpha prefix list so that you can easily identify correct BCBS plan. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. Third, it can help you make more informed decisions to choose right insurance plan and benefits. Call 1-800-388-3193 . Let's start with you. Here Letter R indicates BCBS FEP prefix. Not assigned prefix. eah xp`}L s1zIq%A9Zc~(Iz~HQu;AT#2$ Wp`Hlpp6NQIV0hg`,g H20[20* ": BCBS Prefix List Lookup 2023 - Latest Blue Cross Blue Shield Directory PAJ. 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. Xceed Billing Solutions motive is to create ease for providers, medical billers, patients and everyone who is involved in revenue cycle process. For example: A2A12345678 Here " A2A" is BCBS alpha numeric prefix. Northwest Arizona Employee Benefit Trust (NAEBT) Group # 037461 . 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. Unraveling the Truth, United Healthcare Claims Address, Payer ID, Fax and Phone Number, BCBS Prefix List 2023 Alpha Prefix and Alpha Number Prefix Lookup, BCBS Alpha Numeric Prefix from L2A to L9Z (Updated 2023), BCBS Provider Phone Number for Claims and Eligibility Verification, Benefits and Eligibility Verification Services. 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 Alpha Prefix list is useful for both providers and BCBS enrolled members/patients. If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance. Decide on what kind of signature to create. 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. BCBS prefix are easy to identify using our BCBS prefix lookup because they're part of every BCBS member ID and we included all of them here in the BCBS prefix list. For Example: ABC, A2B, 2AB, 2A2 etc. BCBS National accounts are employer groups that have outlets/offices in multiple states but they offer limited coverage to their employees. We have a track record of providing quality medical billing services to multiple healthcare organizations and specialty providers across USA. You may also want to know: United Healthcare Claims Address Information. Enter a location and search by doctor or hospital name, health condition, or specialty. %{!]/Ox^ A[BXe S#(Df Commercial Communications Suite S . For example: ABC12345678 Here " ABC" is BCBS alpha prefix. 389 0 obj <>/Encrypt 366 0 R/Filter/FlateDecode/ID[<8909369792D16D43815F0147FF33489A><8FFDC42F54ADC847B845BC8E43A10252>]/Index[365 40]/Info 364 0 R/Length 117/Prev 191516/Root 367 0 R/Size 405/Type/XRef/W[1 3 1]>>stream PDF 2021 Commercial Prior Authorization Requirements Summary By doing it may cause delay in processing or handling the claim. Correct BCBS home plan can easily be identified using our BCBS prefix lookup directory. Curious to know what are national Accounts? Narrow Network: Provider participation is by invitation. New BCBS Alpha Numeric Prefixes | My Payer Directory Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. e@'SZD/KCbv*pKq~ The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. To view this file, you may need to install a PDF reader program. 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. 1229 0 obj <> endobj 15456 0 obj <>stream 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. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. The site may also contain non-Medicare related information. There are several benefits of using our BCBS Prefix Lookup tool. 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. PDF Blue Cross and Blue Shield of Minnesota and Blue Plus Commercial Prior BCBS alpha numeric prefix digits are usually in between the prefix e.g. Prefix Group Address Group Name TPA Name & Address Claims Filing Claims & Benefit Contact Name Phone . BCBS Prefix will not only have numbers and the digits 0 and 1. 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. Note: BCBS FEP (Federal Employee Program) ID starts with the alphabet R follow by the insured ID number (For Example: R987654321). This indicates that the claims are excluded from the BlueCard Program. Please look for instructions or a phone number on the back of the member ID card. endstream endobj 1230 0 obj <. hbbd```b``A$ Please DO NOT randomly select a three-character prefix. Box 805107, Chicago, Illinois 60680-4112. BCBS is one of the largest medical insurance company by total members of more than 45 million. Benefits and eligibility should be verified for all members prior to rendering services. Medicare Working or retired, we'll help you every step of the way to find the right plan. Coverage Period: 01/01/2021 - 12/31/2021 . Second Character G assigned to the BCBS Plan as well. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Yes, Policy number same as member ID number and also known as subscriber ID number. On the other hand, the BCBS member ID number is a unique identifier assigned to each individual member covered under a BCBS health insurance policy. 741 0 obj <> endobj The site may also contain non-Medicare related information. 404 0 obj <>stream We make sure to update the information on daily basis, however, if you find some kind of inaccurate information, feel free to contact us. endstream endobj startxref We always make sure to keep BCBS prefix list and BCBS provider phone numbers directory up to date. Normally, account specific prefix associates to the employer group name. %%EOF It means that BCBS members IDs prefixes will must have alphabets. BCBS Railroad member IDs are assigned to members who served in railroad organizations. 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. Always use the BCBS prefix on the members current ID card followed by the member id number. For Example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU etc. 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. PDF Network Prefix List - CareFirst Provider Why does BCBSAZ update member accounts and . BCBS Prefix List Z2A to Z9Z - Alpha Numeric Lookup 2022 The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. Does BCBS policy number same as BCBS member ID number? 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. This new site may be offered by a vendor or an independent third party. nKvo2>)*Y=}4i,+s[yL*2#kN@r115};|`R[5/iZ 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. One option is Adobe Reader which has a built-in reader. In the District of Columbia and . No, the BCBS policy number is not typically the same as the BCBS member ID number. If you have any questions, call the number on the members ID card. 01/01/2021 . =&m$ z90P&\:?$IRIj"c5l\"aD(@?Yuk>{8lkelu3X*FpT=6Rv;9'*4O-o|ELLG?-Yec,cqh(e96e4^QyD8H}'o(3 Most Blue Cross Blue Shield (BCBS) member IDs begin with a three-character prefix. It is used to identify and track the healthcare coverage and benefits for that specific member. BCBS Alpha prefix are the three characters at the start of each BCBS insurance member ID. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. All prefixes are unique. for medical policies and prior authorization requests . PDF 2021 Three Character Prefix In case, you need any additional information related to BCBS prefix then feel free to reach out to us. Hi, Im Kim Keck! 1 of 7. 0 761 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 eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. %%EOF External link You are leaving this website/app (site). We offer a wide choice of individual plans to fit your health needs and budget. American Health Group (AHG) Call 1-800-847-7605 . 0t9~pE_ >if}~t~iM 'yn8Pgi |hxQD_Y. 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.