bcbs prefix list 2021 pdf

We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan information. 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. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Xceed Billing Solutions is amedical billing company for outsourcing medical billing services. This new site may be offered by a vendor or an independent third party. Make sure to make copies of the front and back of member ID card. PAH. It allows you to quickly and easily identify your insurance home plan, saving you time and hassle. 0 One option is Adobe Reader which has a built-in reader. endstream endobj startxref eah xp`}L s1zIq%A9Zc~(Iz~HQu;AT#2$ Wp`Hlpp6NQIV0hg`,g H20[20* ": 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. In the District of Columbia and . 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. BCBS Alpha Prefix List Hi, Im Kim Keck! Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. 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. ;MTK ", 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). Does BCBS policy number same as BCBS member ID number? Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. We have a track record of providing quality medical billing services to multiple healthcare organizations and specialty providers across USA. endstream endobj startxref BCBS prefix are easy to identify using our BCBS prefix lookup because theyre part of every BCBS member ID and we included all of them here in the BCBS prefix list. hbbd```b``"`r9LLN`DR,>6l30&U$60D2HO rH+H f`bdV8J Here Letter R indicates BCBS FEP prefix. 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) . These BCBS prefix may include alpha and numerical characters. The most important and easy way to identify BCBS member is his BCBS member ID alpha prefix. External link You are leaving this website/app (site). 741 0 obj <> endobj 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. Due to the exceeding number of BCBS insurance members, Alpha-Only Prefix member IDs exhausted. The three-character prefixes listed do not represent an exhaustive listing of prefixes. 0 1268 0 obj <>stream 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. These prefixes may include alpha and numerical characters. PAGE : Amkor Technology, Inc. Group # 039176 : AmeriBen . %PDF-1.5 % %%EOF e@'SZD/KCbv*pKq~ We make sure to update the information on daily basis, however, if you find some kind of inaccurate information, feel free to contact us. Save my name, email, and website in this browser for the next time I comment. I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. Coverage Period: 01/01/2021 - 12/31/2021 . 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. BCBS National accounts are employer groups that have outlets/offices in multiple states but they offer limited coverage to their employees. For Example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU etc. You may also want to know: United Healthcare Claims Address Information. Xceed Billing Solutions motive is to create ease for providers, medical billers, patients and everyone who is involved in revenue cycle process. 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. . Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Suite S . K8Y . %PDF-1.6 % 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. hb```I! Most PDF readers are a free download. Prefix ZGP identifies Blue Cross Blue Shield of Texas PPO Product. Correct BCBS home plan can easily be identified using our BCBS prefix lookup directory. Call 1-800-388-3193 . %%EOF 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. 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. Member ID cards with no prefix Some member ID cards may not have a prefix. Have a look at our BCBS alpha prefix and BCBS alpha numeric prefix directory below. For example: ABC12345678 Here " ABC" is BCBS alpha prefix. Most Blue Cross Blue Shield (BCBS) member IDs begin with a three-character prefix. Medicaid 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. endstream endobj startxref %%EOF This can be especially helpful if youre in a rush or need to access your BCBS prefix home plan information quickly. 365 0 obj <> endobj BCBS Alpha Prefix Its a three letter alpha prefix followed by id number. 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 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. Commercial Communications a'm In addition, some sites may require you to agree to their terms of use and privacy policy. 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. BCBS prefix is a three character prefixes followed by the id number except for the following products and programs. 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. 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. Few times, BCBS plan members doesnt have prefix mentioned on their BCBS Insurance card. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. By knowing the details of BCBS home plan, including BCBS insurance plan benefits, coverage options, and costs, you can make better decisions about your healthcare needs. 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. These plans provide health insurance coverage for railroad employees, retirees, and their eligible dependents. 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 Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. So, to accomplish our goal, we have listed down the complete BCBS alpha prefix list so that you can easily identify correct BCBS plan. It shows that these type of BCBS member IDs are different. %PDF-1.6 % `xn_F-y(MQ&O!y1?-uZ=t'=E$r2$IA)gYWp&g` PREFIXES . BCBS prefix lookup directory is a valuable resource for anyone who is looking for right Blue Cross Blue Shield home plan. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Contact us to learn how we can improve your revenue cycle. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. BCBS Alpha Numeric Prefix - It's a three letter Alpha numeric prefix followed by id number. Secondly, it ensures that you have the most up-to-date information about each and every BCBS prefix home plan because we update the BCBS prefix list on daily basis. BCBS Prefix can be classified as follows: BCBS Alpha Prefix - It's a three letter alpha prefix followed by id number. Why does BCBSAZ update member accounts and . Final Instructions about BCBS Prefix Lookup, United Healthcare Claims Address Information. What is Medical Billing and Medical Billing process steps in USA? Born in Texas, USA. Below in our BCBS prefix lookup directory, you can lookup all the BCBS prefix appropriate home plans and their contact information. 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 member ID have maximum 17 characters but most of the member IDs have 12 characters. Curious to know what are national Accounts? Title: It means that BCBS members IDs prefixes will must have alphabets. For example: A2A12345678 Here " A2A" is BCBS alpha numeric prefix. 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. External link You are leaving this website/app (site). 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. 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. Stand-alone dental products, vision and pharmacy when delivered through an intermediary model. Member identification numbers beginning with R belong to Federal Employee Program (FEP) and will not have a three-character prefix when filing. To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. Please look for claim filing instructions on the back of the ID card. Note: Current three-character, alpha-only prefixes will not be affected by this change. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. for medical policies and prior authorization requests. 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. 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. So the next time you need to identify accurate BCBS prefix home plan, remember to use the BCBS prefix list lookup finder. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. 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. BCBS Prefix will not only have numbers and the digits 0 and 1. Note: BCBS FEP (Federal Employee Program) ID starts with the alphabet R follow by the insured ID number (For Example: R987654321). Box 7930 Philadelphia, PA 19101-7930 Medicare Working or retired, we'll help you every step of the way to find the right plan. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue . %PDF-1.6 % A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. BCBS Alpha prefix are the three characters at the start of each BCBS insurance member ID. nKvo2>)*Y=}4i,+s[yL*2#kN@r115};|`R[5/iZ The policy number is usually provided to the policyholder, who is the individual or entity that holds the insurance policy. 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. BCBS Prefix will not only have numbers and the . 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: This indicates that the claims are excluded from the BlueCard Program. We make it easy for you to offer the healthcare coverage that delivers for your business. To identify the plan that holds the members benefits, please call the Out-of-State Blues Plan Subscriber #: 1-800-676-BLUE (2583). Does policy number same as member ID number? 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 What is a member ID prefix? BCBS alpha numeric prefix contains alphabets as well as digits ranging from 1 to 9. You may also be interested to read about denial code 27 reason and solutions. Narrow Network: Provider participation is by invitation. The SBC shows you how you and the plan would share t. he cost for covered health care services. 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. T. he Summary of Benefits and Coverage (SBC) document will help you choose a health. For Federal Employee Program (FEP) precertification requirements, please see the separate FEP precertification list. Benefits Administration Corporation, Inc. (BACI) 9411 Philadelphia RD. BCBS Railroad member IDs are assigned to members who served in railroad organizations. 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. bcbs prefix list PDF,Doc ,Images [PDF] Common Prefix Portal List PBC Premera Blue Cross Three Character Prefixes. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. "Y24Oz>V ?I L r%dl=vHd z/;/X #k> Gq 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. Codes may chan ge, and this list may be updated throughout the year. 1254 0 obj <>/Filter/FlateDecode/ID[]/Index[1229 40]/Info 1228 0 R/Length 122/Prev 219460/Root 1230 0 R/Size 1269/Type/XRef/W[1 3 1]>>stream Group Name. Prefix UTS assigned to University of Texas. Account Specific Prefix are assigned by BCBS to national accounts. 8772287268 Mail Administrator P.O. Baltimore, MD 21237 . 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. To view this file, you may need to install a PDF reader program. First Character Z assigned to the BCBS Plan. Second Character G assigned to the BCBS Plan as well. In that case claim may be denied as Submit the claim to the correct address / Member ID not found. AZBlue - Blue Cross Blue Shield of Arizona - Health Insurance Plans A healthier Arizona is what we're all about. It is used to identify and track the healthcare coverage and benefits for that specific member. 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. endstream endobj 742 0 obj <. To view this file, you may need to install a PDF reader program. Let's start with you. We offer a wide choice of individual plans to fit your health needs and budget. The prefix may also route claim status inquiries and remit searches. Lo-+J52(h' If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance. Blue Cross and Blue Shield of Illinois, P.O. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. This step will help you determine if prior authorization may be required for a specific member and service. Availity provides administrative services to BCBSIL. Blue Cross Select Silver. endstream endobj 1230 0 obj <. Most PDF readers are a free download. 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. 0t9~pE_ >if}~t~iM 'yn8Pgi |hxQD_Y. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. BCBS Railroad refers to Blue Cross Blue Shield health insurance plans that are specifically designed for members who are affiliated with railroad organizations in the United States. Learn more about timely filing limits and CO 29 Denial Code. Commercial Prior Authorization Summary and Code Lists endstream endobj startxref Complete patient information, on the other hand, allows your claims to process without delays. for medical policies and prior authorization requests . 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. The prior authorization information in this notice does not apply to requests for HMO members. To identify correct blue cross blue shield department, they use three characters BCBS prefix in the start of each BCBS member plan ID. 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: The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. 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$u ad#B cG BlueCard. %{!]/Ox^ A[BXe S#(Df This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. hbbd```b``A$ One option is Adobe Reader which has a built-in reader. TT$%b"Dg!h^`]-ce?i8xRiu1IrD-%oR#yt;JBOJ#"TXwD0L Fw,]xS_CU3zf]06_T} PNGCqWV^UET6X~`U The following summaries and related prior authorization lists were posted on the Support Materials (Government Programs) page as of Jan. 1, 2021: Important Reminder: Check Eligibility and Benefits First plan. BCBS is one of the biggest insurance companies in USA and serving more than 106 million people. The prefix routes eligibility/benefits inquiries and claims to the appropriate BCBS Plan or system for timely processing. Independence Blue Cross* Quick Reference Guide . American Health Group (AHG) Call 1-800-847-7605 . 800-676-2583. 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. Three-Character Prefixes. 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. q8-_?UT"X e+1?#7DMKHY]?R,-e;PE\mL TPA Name & Address. And to manage such a big network, they divided it into different departments state wise or employer specific. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Prefix Group Address Group Name TPA Name & Address Claims Filing Claims & Benefit Contact Name Phone .

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