In the District of Columbia and . For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. An incorrect or missing three-character prefix may cause possible delays in the processing of your claims. The three-character prefixes listed do not represent an exhaustive listing of prefixes. It means that BCBS members IDs prefixes will must have alphabets. External link You are leaving this website/app (site). Narrow Network: Provider participation is by invitation. 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. 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. %%EOF PAH. NBT . 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 . 1268 0 obj <>stream a'm Our Health Choice plans are available to Arizonans who qualify for Medicaid. 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. 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 Blue Cross and Blue Shield of Illinois, P.O. We make it easy for you to offer the healthcare coverage that delivers for your business. Xceed Billing Solutions motive is to create ease for providers, medical billers, patients and everyone who is involved in revenue cycle process. To view this file, you may need to install a PDF reader program. We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan information. endstream endobj startxref nKvo2>)*Y=}4i,+s[yL*2#kN@r115};|`R[5/iZ It is used to identify and track the healthcare coverage and benefits for that specific member. If you have any questions, call the number on the members ID card. %PDF-1.6 % What is Medical Billing and Medical Billing process steps in USA? Codes may chan ge, and this list may be updated throughout the year. BCBS is one of the largest medical insurance company by total members of more than 45 million. And to manage such a big network, they divided it into different departments state wise or employer specific. What is the difference between BCBS alpha prefix and BCBS alpha numeric prefix? What is a member ID prefix? A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. 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. 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. Few times, BCBS plan members doesnt have prefix mentioned on their BCBS Insurance card. What If BCBS Member ID doesnt have Prefix mentioned on Card? Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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. Does policy number same as member ID number? eO\v; tU9kN@]fh:~q:Fye{Q)ihJ HP/VD/_oy\ H ~fa4L?!ekF(\0>o for medical policies and prior authorization requests . Hi, Im Kim Keck! Please look for instructions or a phone number on the back of the member ID card. 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. The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. T. he Summary of Benefits and Coverage (SBC) document will help you choose a health. Benefits Administration Corporation, Inc. (BACI) 9411 Philadelphia RD. 0 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 BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. Make sure to make copies of the front and back of member ID card. BCBS prefix lookup directory is a valuable resource for anyone who is looking for right Blue Cross Blue Shield home plan. For Example: ABC, A2B, 2AB, 2A2 etc. 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. Second Character G assigned to the BCBS Plan as well. BCBS Alpha Numeric Prefix Its a three letter Alpha numeric prefix followed by id number. The member ID number may be different for each member covered under the same policy, and it is typically used when seeking medical services, submitting claims, or accessing healthcare benefits. To view this file, you may need to install a PDF reader program. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. hb``` eaXm.; `Umap@LDPpN jM*,BDu|m_(2*u x y-a`b` #; 0 We always make sure to keep BCBS prefix list and BCBS provider phone numbers directory up to date. The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. 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. Let's start with you. Most PDF readers are a free download. Complete patient information, on the other hand, allows your claims to process without delays. `xn_F-y(MQ&O!y1?-uZ=t'=E$r2$IA)gYWp&g` BCBS prefix is a three character prefixes followed by the id number except for the following products and programs. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. AZBlue - Blue Cross Blue Shield of Arizona - Health Insurance Plans A healthier Arizona is what we're all about. 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. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Xceed Billing Solutions is amedical billing company for outsourcing medical billing services. 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 BCBS FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. American Health Group (AHG) Call 1-800-847-7605 . So, all BCBS plans, including Anthem prefix and Non-Anthem plans announced that member IDs will also be Alpha Numeric from 2018 onwards. 777 0 obj <>stream BCBS Prefix will not only have numbers and the digits 0 and 1. 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. To identify the plan that holds the members benefits, please call the Out-of-State Blues Plan Subscriber #: 1-800-676-BLUE (2583). 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. The site may also contain non-Medicare related information. Medicaid It shows that these type of BCBS member IDs are different. by calling 1-844-377-1278 (BCN) or 1-800-728-8008 (Blue Cross) or by logging oncology and in to the AIM ProviderPortal. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. 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. . BCBS alpha prefix only contains alphabets and each alpha prefix represents different BCBS home plan. 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: %%EOF $=0j]xkM#[f4YgI|in Z(0zF1-9gk!D @WeUUn/R%$'c|J6:z}\}8ZNd+SL5-h"\wE$w{3\zO>,Vta$a`D7rHmr$bwZm7yYO)&^E<2@9#&UDOz Prior Authorization List for Blue Shield Effective April 1, 2023 (This list is updated monthly) blueshieldca.com 601 12th Street | Oakland, CA 94607 Blue Shield of California is an independent member of the Blue Shield Association April 1, 2023 Page 1 of 8 Policy Name/Program Procedure Code (To search, press Ctrl + F) . BCBS Prefix List 2021 - Alpha State Lookup BCBS Company; AAA: Alabama: Blue-Cross Blue-Shield of Alabama: AAB: Michigan: Blue-Cross Blue-Shield of Michigan: AAC: Illinois: Blue-Cross Blue-Shield of Illinois: AAD: South Carolina: Blue-Cross Blue-Shield of South Carolina: AAE: Nevada: O}BAXv:OP)Qt9>PN,RG4uZu~?raYW+Q`|w[OD klW1Kg|'6'8=rRW00+,oD~`Ox(4DLMm,$Uy69r!$w0.<5>gJd'0?wf\2t| :\xQ cwh)}Ycb8I5vg~TQNnx^Y$M'JL+0?\:3Y(+Sb1:_%^uur(h>mS These BCBS prefix may include alpha and numerical characters. eah xp`}L s1zIq%A9Zc~(Iz~HQu;AT#2$ Wp`Hlpp6NQIV0hg`,g H20[20* ": Member identification numbers beginning with R belong to Federal Employee Program (FEP) and will not have a three-character prefix when filing. 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. endstream endobj startxref 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. We make sure to update the information on daily basis, however, if you find some kind of inaccurate information, feel free to contact us. "Y24Oz>V ?I L r%dl=vHd z/;/X #k> Gq Title: TT$%b"Dg!h^`]-ce?i8xRiu1IrD-%oR#yt;JBOJ#"TXwD0L Fw,]xS_CU3zf]06_T} PNGCqWV^UET6X~`U K8Z : Page 2 . =&m$ z90P&\:?$IRIj"c5l\"aD(@?Yuk>{8lkelu3X*FpT=6Rv;9'*4O-o|ELLG?-Yec,cqh(e96e4^QyD8H}'o(3 We offers a wide range of RCM solutions to improve your healthcare services financial health and allows you to focus on patients care rather than collecting payments from insurances and patients for services performed. %%EOF Learn more about timely filing limits and CO 29 Denial Code. Lets dig into it! The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). PREFIXES . BlueCard. One option is Adobe Reader which has a built-in reader. BCBS prefix List plays a vital role in filing the health care claims properly to the correct BCBS address and also to verify members eligibility, health insurance coverage information and to reach the correct BCBS department to check the claim status or disputes of the claim. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. 15456 0 obj <>stream %{!]/Ox^ A[BXe S#(Df First, it saves you time and hassle by allowing you to quickly identify correct BCBS insurance home plan without having to call customer service. TPA Name & Address. So, to answer this query, we have mentioned below few important points to consider. Does BCBS policy number same as BCBS member ID number? Prefix Group Address Group Name TPA Name & Address Claims Filing Claims & Benefit Contact Name Phone . Always make sure to submit claims to insurance company on time to avoid timely filing denial. 'MNiXG]dRBC; 0'Va~9&c}Ag$Pge;\UY,$MtN 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. Have a look at our BCBS alpha prefix and BCBS alpha numeric prefix directory below. Working or retired, we'll help you every step of the way to find the right 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. Each BCBS alpha numeric prefix represents different BCBS home plan. You may also want to know: United Healthcare Claims Address Information. For example: ABC12345678 Here " ABC" is BCBS alpha prefix. It clarifies a utilization management vendor change for specific members. 0t9~pE_ >if}~t~iM 'yn8Pgi |hxQD_Y. 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. In case, you need any additional information related to BCBS prefix then feel free to reach out to us. (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. In that case claim may be denied as Submit the claim to the correct address / Member ID not found. 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. 0 Plan Type: PPO . %PDF-1.5 % 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. BCBS Alpha prefix lookup contains all the Blue Cross Blue Shield alpha prefix along with their home plan and website. 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. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists 741 0 obj <> endobj 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. ?} AN A2Z, G2A, J4K etc. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. hbbd```b``"`r9LLN`DR,>6l30&U$60D2HO rH+H f`bdV8J You may also be interested to read about denial code 27 reason and solutions. All prefixes are unique. BCBS Alpha prefix are the three characters at the start of each BCBS insurance member ID. The policy number is a unique identifier which may cover multiple members under the same policy, such as a family or a group. PAGE : Amkor Technology, Inc. Group # 039176 : AmeriBen . Contact us to learn how we can improve your revenue cycle. 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. Independence Blue Cross (BC) of Philadelphia (Phi) and the Southeastern Pennsylvania (PA) PAI. There are three variants; a typed, drawn or uploaded signature. PAJ. Final Remarks about BCBS Prefix Lookup Directory. First Character P is symbolizing that member plan/product type is BCBS PPO. 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. Blue Cross Select Silver. Last updated: 07/01/2022. The most important and easy way to identify BCBS member is his BCBS member ID alpha prefix. We offer a wide choice of individual plans to fit your health needs and budget. This new site may be offered by a vendor or an independent third party. plan. In addition, some sites may require you to agree to their terms of use and privacy policy. BCBS is one of the biggest insurance companies in USA and serving more than 106 million people.
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