regence claims address

0000128769 00000 n DJP BCBS of Nebraska What do I do if a member has an identification card without an alpha prefix ? We send the member a questionnaire requesting information to determine if benefits are available. In general, there are two categories of alpha prefixes namely account specific and plan specific alpha prefixes. Claims submission Learn more about billing and how to submit claims to use for payment. Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. Electronic Transactions and Claim Payer ID, Resource-based relative value scale (RBRVS), Claims from Non-credentialed contracted providers, federal and Washington state civil rights laws, Subscriber's number and patient suffix number (including plan prefix) assigned by plan as shown on the member's identification card, Number assigned by the clinic for patient. We will notify you once your application has been approved or if additional information is needed. Units shown in box 24G of the CMS-1500 form. Blue Cross and Blue Shield of Illinois (BCBSIL) members ID cards in the BlueCare Direct and Blue Choice Preferred PPO plans have been updated. 0000013357 00000 n A comprehensive list is posted in the Library under Reference Info. CUP CBA BLUE (BCBS VT) When a member is the subscriber on more than one plan, when both plans have a COB provision, the plan with the earliest start date pays first (primary). Open 24 hours a day, 7 days a week. AFS Blue Shield of California All services rendered by the same provider for the same patient for the same date of service must be submitted on one claim form. You can submit claims daily, weekly, or monthly. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. CWR Anthem Blue Cross of California Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do. This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. Its often confused that BCBS have lot of prefixes and where to contact. Supplier Registration Federal Employee Program Overseas Claims P.O. Bill all original lines-not including all of the original lines will cause the claim to be rejected. Disclosure Notice Patient Protection Surprise Billing, 270/271 Eligibility inquiry and response, 278 Referral certification and authorization, 837 Claims and encounters (P, D, and I). CUR Healthnow of NY Buffalo Centers of Excellence Program administered by Premera Phone: 1 (855) 784-4563 TRS: 711 Business hours: Monday through Friday 7 a.m. to 5 p.m. (Pacific), Puget Sound High Value NetworkPhone: 1 (855) 776-9503TRS: 711Business hours: Monday through Friday 7 a.m. to 7 p.m. (Pacific), UW Medicine Accountable Care NetworkPhone: 1 (888) 402-4237TRS: 711Business hours: Monday through Friday 5 a.m. to 8 p.m. (Pacific). Mailing address: Blue Cross of Idaho. We can process the claim after we receive that information. 0000015026 00000 n Alpha Prefix, The three-character alpha prefix at the beginning of the members identification number is the key element used to identify and correctly route claims. We regularly update (at least quarterly) our claims editors to keep pace with changes in medical technology, as well as CPT codes, HCPCS codes, and ICD-10-CM/PCS Diagnosis and Procedure code changes, standards, and complexities. Washington Help Center: Important contact information for Premera Blue Cross, and Regence BlueShield. Health . Claims and clinical appeals address: PO Box 21702 Eagan, MN 55121 Care management Phone: 844-996-0329 Fax: 888-302-9325 2023 holiday closures January 2 May 29 July 4 September 4 November 23 November 24 December 25 A required waiting period must pass before we can provide benefits for this service. The three characters preceding the subscriber identification number on BCBS member ID cards. CZG Premera Blue Cross of Washington ACS BCBS of IL YDZ SG OFF Exchange CVP Anthem BCBS of Ohio | the instructions to determine where to send claims or correspondence. *Follow instructions on these ID cards to verify eligibility, submit claims and obtain health plan contact information. When you go to this page, you should see a dialog box that asks for your ZIP code. %%EOF Uniform Medical Plan (UMP) offers you five different health plans through Washington state's Public Employees Benefits Board (PEBB). Lack of credentialing can be grounds for termination from Premeras network. Portugus | The member's benefit program contains special provisions for benefits when an injury or condition is: An onset date should be recorded on all accident-related claims. All other related costs incurred by the parties shall be the responsibility of whoever incurred the cost. Franais | If you have questions about COB, contact Customer Service by calling the phone number on the back of the member's ID card. Find Contact Information. Friday 6:00 AM. BET PA BC PA, 120 Fifth Ave , Pittsburgh , PA , 15222-3099 412-544-7000, BFM PA BC PA Highmark, POB 176 , Pittsburgh , PA , 15230-0176 866-316-6339, BGH AL BCBS of Alabama, POB 995 , Birmingham , AL , 35298 205-988-2213, BGP MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BHP PA BC PA, POB 778988 , Harrisburg , PA , 17177-8988 800-222-3341, BIM MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237, BMI IN BCBS of Indiana, 120 Monument Circle , Indianapolis , IN , 46204 317-488-6000, BOG MI BC MI, POB 1618 , Detroit , MI , 48231 800-462-7237 We can process the claim after we receive that information. When applicable, we will suspend payment until we determine which carrier is primary and which is secondary. 0000006620 00000 n We are now processing credentialing applications submitted on or before March 14, 2023. CYV Anthem BCBS of Missouri Who do I contact for EDI questions? The ID cards also may have: If we do not receive the EOB and are unable to obtain the primary payment information by phone, the claim will be denied with a request for a copy of the primary EOB before processing can be completed. Find the correct address listed under the type of service received (see explanation). You can recognize Managed Care/POS members who are enrolled in out-of-area networks through the member identification card as you do for all other BlueCard members. 1-800-962-2731. $25 will continue to accrue until it reaches that threshold or until December of each year. To ensure prompt and accurate payment when Premera is the secondary carrier, we encourage you to send the secondary claims with the primary processing information as soon as you receive it. Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. We abide by the following COB standards to determine which insurance plan pays first (primary carrier) and which pays second (secondary carrier). Seattle, WA 98111-9202, Back to Medical Reference Manuals overview, Espaol | You may have invested in the account specific alpha prefix health insurance plan from BSBS at this time. Coding toolkit View our clinical edits and model claims editing. 0000018886 00000 n Related . PO Box 52080 ADQ Independence Blue Cross 02/16/2023 Retirement Workshop in Lacey on Feb. 18. . AAB BCBS of Michigan UMP members: If you are outside the U.S. and you have questions about your benefits and coverage, you can contact UMP Customer Service by signing into your Regence account and selecting chat live or email through the Message Center. 1 (888) 675-6570 Prescription questions? https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. Generally, if the court decrees financial responsibility for the child's healthcare to one parent, that parent's health plan always pays first. If you submit your claims electronically, you may receive electronic remittance for the following: Remittance is available online-just let us know. We also apply the following Prompt Pay standards set by the State of Alaska to our claims adjudication process in order to: Oregon contracted and non-contracted Invalid claims are reported back to the provider with rejection details. We follow industry standard coding recommendations and guidelines from sources such as the CMS, CPT, and AMA, and other professional organizations and medical societies and colleges. We're here to help (651) 662-5200 1-800-262-0820 . Subrogation permits the plan to recover payments when the negligence or wrongdoing of another causes a member personal illness or injury. Box 91102 Since new ID cards may be issued to members throughout the year, this will ensure that you have the most up-to-date information in your patients file. Precertification remains the responsibility of the provider for all Empire HMO network members. Please reach out and we would do the investigation and remove the article. DJE BCBS of Alabama If the information is not captured correctly, you may experience a delay with the claim processing. AAY Wellmark BCBS Iowa/South Dakota AGT Blue Shield of California You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. If you are outside the U.S. and need to find a local provider, make an appointment or be hospitalized, call Blue Cross Blue Shield Global Core at 1-800-810-2583 or call collect at 1-804-673-1177, 24 hours a day, 7 days a week. Premera Blue Cross & The Regence Group Common Alpha Plan Prefixes Last updated: 09/01/2016 Premera Blue Cross & Premera Blue Cross/NASCO Prefixes Western WA providers submit claims to Regence Blue Shield. providers: We process your claim as soon as we receive them. We need the member to promptly complete and return this questionnaire to process claims in a timely manner. ** PPOB in a suitcase logo, for PPO members with access to the BlueCard PPO Basic network treatment center. Use find (Ctrl + F) and enter the prefix to find the BCBS state. Once the claim is found, you can click on original EOP view to pull up this information. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. 7:00 AM - 6:00 PM PSTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care AFP Anthem BCBS of Ohio Prefixes with * include all characters for the 3rd position unless otherwise . complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. All of our contracts exclude coverage for care covered under the Workers' Compensation Act. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. See our FAQs for more claim information and contacts. All people who have BCBS health insurance policy have to make copies of their ID front and back and keep such records on hand. Your member ID card is your key to using your medical plan benefits. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. ), Charges billed by physician/provider at a line item level, Amount allowed for service at a line item level, Adjudication explanation code(s) at a line item level and claim level (if applicable), Printed at the end of each claim, the line items are summed and an asterisk indicates the claim total line, Less Paid to Codes Listed as S or C, The sum of the claim total Payable Amounts which have a PD TO code of S or C, The sum of any amount withheld and applied to a prior refund or recovery. If that dialog box did not appear, click the "(change)" link next to the "ZIP code" label. Pay or deny 95 percent of a provider's monthly volume of all claims within 60 days of receipt. from receipt of the information. UMP administered by Regence BlueShield (Medical only) (UMP Achieve 1, UMP Achieve 2, UMP High Deductible, UMP Plus) Online: Uniform Medical Plan for school employees. We are unable to quote a benefit by a code. This review is necessary to determine whether the claim(s) should be covered by a first-party carrier (e.g., PIP, Med Pay or similar coverage - homeowners or a commercial medical premise policy). All Blue Plans replaced Social Security numbers on member ID cards with an alternate, unique identifier. AEG Anthem BCBS of Ohio Receiving payment Need information from the member's other insurance carrier to process claim. AFZ Anthem Blue Cross of California CUU BCBS of Texas 0000014956 00000 n providers: We process your claim as soon as we receive them. If there is no alpha prefix, do not create one or use an alpha prefix from another members ID card, even one from the same BCBS Plan. ** A local network identifier, (for example, BlueMark) 0000003471 00000 n CVZ Horizon BCBS of New Jersey How do I identify international members? PO Box 1106. Call Customer Service and choose the Pharmacy option. You can reach Customer Service by calling 877-342-5258, option 2. AAT Anthem Blue Cross of California Note that some processing systems may have a limitation regarding the number of characters recognized. Franais | YDV SG ON Exchange Provider who rendered the service. Verify benefits or eligibility for BlueCard members. Enter the three digit alphanumeric prefix located on the member's ID card, and the tool provides the correct insurance carrier for you. You must request mediation in writing within 30 days after receiving the Level II appeals decision on a billing dispute. Get immediate member information by phone or fax . On the Availity Web Portal, you can: Run transactions to obtain member benefit, eligibility and claims information. You can verify your address by calling PEBB Customer Service at | ABJ BCBS Minnesota You will need special software to send insurance claims electronically. accrue interest on the 31st day from receipt of the information. AGX Anthem BCBS of Virginia View your credentialing status in Payer Spaces on Availity Essentials. Only appeals received within this period will be accepted for review. CYP BCBS of IL startxref Provider: please send us the member's lab results for this claim. CWH Anthem Blue Cross of California For information that cannot be served by Availity Essentials or our self-service tool, our Provider Contact Center is available Monday through Friday, 6 a.m. - 5 p.m. (PT). The provider appeals process does not apply to FEP, BlueCard Home Claims, Medicare Supplement plans, or Medicare Advantage plans. There is no charge to healthcare providers who submit electronic claims directly to us. We notify you in writing if the Level II appeal is not timely and your appeal rights will be exhausted. If all pertinent information is obtained, the claim(s) will then be processed according to the member's contract benefits. We haven't received the information. Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. Box 105557. . Verify eligibility via Highmarks NaviNet. Web: Regence BlueShield. Our medical staff reviewed this claim and determined that this service isn't covered by the plan. CMS also uses RVUs to allocate dollar values to each CPT or HCPCS code. The total number of characters in the members ID ranges from six to fourteen. The maximum limit has been met for this benefit. We are now processing credentialing applications submitted on or before March 6, 2023. YUV SG ON Exchange Use 8 to void a claim billed in error, The initial claim number (in loop 2300, REF01 must contain F8 and REF02 must contain the claim number). ACK Anthem Blue Cross of California Call 1 (855) 522-8894. (Note: Claims received with an ICD-9 code will be rejected with a notice to re-bill using ICD-10. . AIA BCBS of Texas ** Verify with the member that the ID number on the card is not his/her Social Security Number. Most BCBS-branded ID cards display a three-character alpha prefix in the first three positions of the members ID number. CVJ BCBS of Florida Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. By continuing to use this website, you consent to these cookies. The preferred process for submitting corrected claims is to use the 837 transaction Our provider complaints and appeals process ensure we address a complaint or an appeal in a fair and timely manner. An EDI representative will review the test claims with you or your vendor. This service is considered a standard exclusion. contracted): If we fail to satisfy any of the above standards, commencing on the 31st day, well pay interest at a 15 percent annual rate on the unpaid or un-denied clean claim. From there, you will be directed to a new site; at this site, enter in your login information. If it is, call the BlueCard Eligibility line 800-676-BLUE (2583) to verify the ID number. All the information are educational purpose only and we are not guarantee of accuracy of information. 0000018992 00000 n . Box 260070 Pembroke Pines, FL 33026 . Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association. If the Level II appeal is timely and complete, the appeal will be reviewed. If we receive the complaint before the 365-day deadline, we review and issue a decision within 30 calendar days via letter or revised Explanation of Payment. 0000008616 00000 n If Workers' Compensation denies payment of such claims, Premera will pay according to the subscriber's contract benefits after receiving a copy of a valid denial. You can submit a complaint about one of our actions (verbally or in writing) to one of our employees. UMP Customer ServicePhone: 1 (888) 849-3681 TRS: 711 Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)Chat Live: Sign in to your Regence account Monday through Friday 7 a.m. to 5 p.m. (Pacific) to access chat live. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. The alpha prefix identifies the Blue Plan or National Account to which the member belongs. Claims & payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. 3. Modifiers. 10700 Northup Way, Suite 100 CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). DJJ Horizon BCBS of New Jersey AEM Highmark BCBS Company Description: Regence BlueCross BlueShield of Oregon provides health insurance products and other managed care services to some 750,000 members in Oregon and Washington's Clark County. ** PPO in a suitcase logo, for eligible PPO members Designed by Elegant Themes | Powered by WordPress. Additional Contact Information Pharmacy Program. AAQ Anthem BCBS of Ohio Regence Provider Appeal Form. Membership Address. Identifying members Easily identify the kind of coverage our members have. Insurance Denial Claim Appeal Guidelines. We will response ASAP. note: Exclusions to paying interest may apply based on line of business. 0000055309 00000 n AFK Empire BCBS AGS Anthem Blue Cross of California ALR AR BC AR, PO Box 2181 , Little Rock , AR , 72203-2180 888-847-1400, AMU RI BCRI, 444 Westminister St , Providence , RI , 02903-3279 401-831-7300, AMZ KY BC KY, POB 37690 , Louisville , KY , 40233 800-925-0135, AON IL BC IL, POB 1364 , Chicago , IL , 60690 800-972-8088, APT DE BC DE, POB 8830 , Wilmington , DE , 19899-8830 800-342-2221 We will send the member an IQ if the claim(s) is potentially accident-related. When a Medicare patient received services that Medicare specifically requires to be submitted on separate claim forms, this one claim requirement will not apply. Appeals rights will be exhausted if not received within the required timeframe. These weights are then multiplied by the dollar conversion factor we publish. | CZB Wellmark BCBS Iowa/South Dakota or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Employees:Contact your payroll or benefits office. However, there are some exceptions.

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