bcbs prefix list 2021 pdf bcbs prefix list 2021 pdf

365 0 obj <> endobj Baltimore, MD 21237 . 0t9~pE_ >if}~t~iM 'yn8Pgi |hxQD_Y. View Medicare information Radiology utilization for Arkansas Blue Cross FEP The site may also contain non-Medicare related information. Not assigned prefix. T. he Summary of Benefits and Coverage (SBC) document will help you choose a health. If you have any questions, call the number on the members ID card. 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. The policy number is a unique identifier which may cover multiple members under the same policy, such as a family or a group. Benefits and eligibility should be verified for all members prior to rendering services. Our Health Choice plans are available to Arizonans who qualify for Medicaid. hbbd``b`f3$ bE FM Dmb"@ $$@z$u ad#B cG 0 Please look for claim filing instructions on the back of the ID card. Box 14115 Lexington, KY 40512 Mail Administrator P.O. Few times, BCBS plan members doesnt have prefix mentioned on their BCBS Insurance card. For providers and medical billers who are performing medical billing services, BCBS alpha prefix are helpful to identify the correct payer ID and address for claims submission. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists =&m$ z90P&\:?$IRIj"c5l\"aD(@?Yuk>{8lkelu3X*FpT=6Rv;9'*4O-o|ELLG?-Yec,cqh(e96e4^QyD8H}'o(3 TT$%b"Dg!h^`]-ce?i8xRiu1IrD-%oR#yt;JBOJ#"TXwD0L Fw,]xS_CU3zf]06_T} PNGCqWV^UET6X~`U 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). Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. . PDF Blue Cross and Blue Shield of Minnesota and Blue Plus Commercial Prior 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. Learn more about timely filing limits and CO 29 Denial Code. plan. There are two types of BCBS prefixes which are mentioned below: Plan Specific prefix are assigned by BCBS to each plan. We recently received a query from a provider that how I can identify that patient is BCBS health insurance member. Medical providers - Arkansas Blue Cross and Blue Shield You can also contact us for specialty medical billing services. PDF Provider Quick Reference Guide - CareFirst 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. Carefirst BCBS of Maryland the (MD), District of Columbia (DC) and the Northern Virginia (VA) %PDF-1.6 % Services that require precertification - IBX Commercial Communications What is Medical Billing and Medical Billing process steps in USA? BCBS Alpha Prefix Its a three letter alpha prefix followed by id number. Why does BCBSAZ update member accounts and . What If BCBS Member ID doesnt have Prefix mentioned on Card? (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.). Box 805107, Chicago, Illinois 60680-4112. American Health Group (AHG) Call 1-800-847-7605 . ", 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). Born in Texas, USA. Prefix UTS assigned to University of Texas. For Example: XYZ123456789. BCBS Alpha Numeric Prefix Its a three letter Alpha numeric prefix followed by id number. BCBS Prefix will not only have numbers and the digits 0 and 1. 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 742 0 obj <. 15363 0 obj <> endobj To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. 404 0 obj <>stream Each BCBS alpha numeric prefix represents different BCBS home plan. Independence Blue Cross (BC) of Philadelphia (Phi) and the Southeastern Pennsylvania (PA) PAI. hbbd```b``"`r9LLN`DR,>6l30&U$60D2HO rH+H f`bdV8J PDF Network Prefix List - CareFirst Provider a'm But dont worry because our BCBS prefix finder include alpha numeric prefix information as well. Box 14114 Lexington, KY 40512 Federal Employee Program (FEP) R prefix DC/Metropolitan Area 2024884900 MD 8008545256 DC/Metropolitan Area Mail Administrator P.O . This step will help you determine if prior authorization may be required for a specific member and service. In some case provider or billing company may file the claim to an incorrect address without checking the correct BCBS address. Regence Prefix List Form - Fill Out and Sign Printable PDF Template I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. 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. BlueCard Program Alpha Prefixes | Blue Cross and Blue Shield - BCBSTX Three-Character Prefixes. To identify correct department, they use 3 characters Prefix in the BCBS members plan ID. PDF 2022 Commercial PA Code Lists December Updates - BCBSIL A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. Address: 11070 Katy Fwy, Houston, TX 77043, 2023 Xceed Billing Solution.com - All Rights Reserved, Blue Cross Blue Shield BCBS Prefix List Lookup. Correct BCBS home plan can easily be identified using our BCBS prefix lookup directory. 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. Does BCBS policy number same as BCBS member ID number? AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. To identify the plan that holds the members benefits, please call the Out-of-State Blues Plan Subscriber #: 1-800-676-BLUE (2583). 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. We have the right plan for you to keep you and your family covered. 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. hb``` eaXm.; `Umap@LDPpN jM*,BDu|m_(2*u x y-a`b` #; First, it saves you time and hassle by allowing you to quickly identify correct BCBS insurance home plan without having to call customer service. 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. 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. 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. `xn_F-y(MQ&O!y1?-uZ=t'=E$r2$IA)gYWp&g` BCBS Prefix List Lookup 2023 - Latest Blue Cross Blue Shield Directory Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Choose My Signature. PREFIXES . The prefix routes eligibility/benefits inquiries and claims to the appropriate BCBS Plan or system for timely processing. 777 0 obj <>stream This indicates that the claims are excluded from the BlueCard Program. BCBS FEP Its indicated with letter R followed by the id number. 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 This new site may be offered by a vendor or an independent third party. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. %%EOF BCBS Prefix List 2023 - Alpha Prefix and Alpha Number Prefix Lookup Lo-+J52(h' The SBC shows you how you and the plan would share t. he cost for covered health care services. 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. What is a member ID prefix? Coverage For: Individual + Family. 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. Codes may chan ge, and this list may be updated throughout the year. 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. How To Identify Blue Cross Blue Shield Member? BCBS prefix lookup directory is a valuable resource for anyone who is looking for right Blue Cross Blue Shield home plan. External link You are leaving this website/app (site). Independence Blue Cross* Quick Reference Guide . 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. BCBS Alpha Prefix Lookup 2023 Decide on what kind of signature to create. 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. therapy) 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) . K8Y . BCBS is one of the largest medical insurance company by total members of more than 45 million. 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. $=0j]xkM#[f4YgI|in Z(0zF1-9gk!D @WeUUn/R%$'c|J6:z}\}8ZNd+SL5-h"\wE$w{3\zO>,Vta$a`D7rHmr$bwZm7yYO)&^E<2@9#&UDOz ?} AN PDF Blue Cross and BCN utilization management medical drug list - BCBSM 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. 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. You may also be interested to read about denial code 27 reason and solutions. Search for doctors near you and in your network. 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 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. 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. %{!]/Ox^ A[BXe S#(Df PAJ. Title: One option is Adobe Reader which has a built-in reader. We have a track record of providing quality medical billing services to multiple healthcare organizations and specialty providers across USA. for medical policies and prior authorization requests . It means that BCBS members IDs prefix will must have alphabets and they may or may not have numbers. Group Name. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 0|kEMi_a*-Yfj#uqEcA/6 .M.6YNw4cyo>lESMC\)H~L 1B> BCBS Alpha Prefix list is useful for both providers and BCBS enrolled members/patients. %%EOF It is used to identify and track the healthcare coverage and benefits for that specific member. eah xp`}L s1zIq%A9Zc~(Iz~HQu;AT#2$ Wp`Hlpp6NQIV0hg`,g H20[20* ": Hi, Im Kim Keck! BCBS Alpha Prefix List from PAA to PZZ Updated 2023 These BCBS prefix may include alpha and numerical characters. Availity provides administrative services to BCBSIL. It allows you to quickly and easily identify your insurance home plan, saving you time and hassle. 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 . 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. Northwest Arizona Employee Benefit Trust (NAEBT) Group # 037461 . It shows that these type of BCBS member IDs are different. Complete patient information, on the other hand, allows your claims to process without delays. Normally, account specific prefix associates to the employer group name. It clarifies a utilization management vendor change for specific members. Due to the exceeding number of BCBS insurance members, Alpha-Only Prefix member IDs exhausted. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). The policy number is usually provided to the policyholder, who is the individual or entity that holds the insurance policy. %PDF-1.5 % Second Character G assigned to the BCBS Plan as well. ;MTK The three-character prefixes listed do not represent an exhaustive listing of prefixes. Most Blue Cross Blue Shield (BCBS) member IDs begin with a three-character prefix. 1 of 7. 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 The most important and easy way to identify BCBS member is his BCBS member ID alpha prefix. Have a look at our BCBS alpha prefix and BCBS alpha numeric prefix directory below. For Example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU etc. We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan information. 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. PAH. q8-_?UT"X e+1?#7DMKHY]?R,-e;PE\mL BCBS Prefix List AAA to AZZ - Alpha Lookup by State 2022 PDF BCBSAZ/TPA Co-Administered Group Plans - AZBlue 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. Lets dig into it! These BCBS prefix may include alpha and numerical characters. 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. For Federal Employee Program (FEP) precertification requirements, please see the separate FEP precertification list. %%EOF Also, these BCBS prefixes helps providers and medical billers to reach the correct claims department for claims and benefits inquiry. All prefixes are unique. BCBS Railroad member IDs are assigned to members who served in railroad organizations. The prefix may also route claim status inquiries and remit searches. In case, you need any additional information related to BCBS prefix then feel free to reach out to us. 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. Prefix ZGP identifies Blue Cross Blue Shield of Texas PPO Product. "Y24Oz>V ?I L r%dl=vHd z/;/X #k> Gq 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 Prefix will not only have numbers and the . Xceed Billing Solutions motive is to create ease for providers, medical billers, patients and everyone who is involved in revenue cycle process. Plan Type: PPO . What is Medical Billing and Medical Billing process steps in USA? What is the difference between BCBS alpha prefix and BCBS alpha numeric prefix? Added to list, with AIM effective 04/01/2021 22802 Joint, Spine Surgery Post Fusion 7-12 Vert Seg SUR712.036 AIM Guidelines Lumbar Spinal Fusion Retire from BCBS PA effective 1/1/22; continue to request PA through AIM if applicable; Added to list, with AIM effective 04/01/2021 22804 Joint, Spine Surgery Post Fusion 13/> Vert Seg SUR712.036 AIM . 15456 0 obj <>stream Prior-Authorization And Pre-Authorization | Anthem.com 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. Please DO NOT randomly select a three-character prefix. For example: ABC12345678 Here " ABC" is BCBS alpha prefix. First Care, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Enter a location and search by doctor or hospital name, health condition, or specialty. by calling 1-844-377-1278 (BCN) or 1-800-728-8008 (Blue Cross) or by logging oncology and in to the AIM ProviderPortal. A2Z, G2A, J4K etc. You may see cards with four-character prefixes, e.g., HMSA Blue Cross Blue Shield of Hawaii uses four-character prefixes. Final Remarks about BCBS Prefix Lookup Directory.