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. PAH. So, to answer this query, we have mentioned below few important points to consider. %%EOF 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 FEP Prefix BCBS Federal Employee Program is identified by the letter R followed by the number. It is used to identify and track the healthcare coverage and benefits for that specific member. %{!]/Ox^ A[BXe S#(Df BCBS Railroad member IDs are assigned to members who served in railroad organizations. 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 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 Most PDF readers are a free download. You may also be interested to read about denial code 27 reason and solutions. 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. nKvo2>)*Y=}4i,+s[yL*2#kN@r115};|`R[5/iZ Wheelchairs - Mobility Assistive Equipment (Manual & Power) & Scooters - Wheelchair Purchase only -Motorized) Wheelchair: E1050, E1060, E1070, E1083, E1084, E1085 . endstream endobj startxref Customer Service: 1-800-409-9462 HCSC-PORT. 0 Blue Cross Select Silver. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. The site may also contain non-Medicare related information. 777 0 obj <>stream 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. To identify correct blue cross blue shield department, they use three characters BCBS prefix in the start of each BCBS member plan ID. 15456 0 obj <>stream 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. BCBS Alpha Numeric Prefix - It's a three letter Alpha numeric prefix followed by id number. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. The prefix may also route claim status inquiries and remit searches. Our Health Choice plans are available to Arizonans who qualify for Medicaid. %%EOF For accurate and quick claims processing, it is necessary to get complete patient insurance information. Box 14115 Lexington, KY 40512 Mail Administrator P.O. Let's start with you. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. ;MTK We update BCBS prefix list data on daily basis to provide latest BCBS prefix home plan information. Baltimore, MD 21237 . There are two types of BCBS prefixes which are mentioned below: Plan Specific prefix are assigned by BCBS to each plan. hbbd``b`f3$ bE FM Dmb"@ $$@z$u ad#B cG One option is Adobe Reader which has a built-in reader. To identify the plan that holds the members benefits, please call the Out-of-State Blues Plan Subscriber #: 1-800-676-BLUE (2583). K8Z : Page 2 . 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). Stand-alone dental products, vision and pharmacy when delivered through an intermediary model. Title: To get information about such member IDs, you can contact BCBS prefix directory phone number i.e. 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. Enter a location and search by doctor or hospital name, health condition, or specialty. For Federal Employee Program (FEP) precertification requirements, please see the separate FEP precertification list. Last updated: 07/01/2022. 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. 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. 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 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Third, it can help you make more informed decisions to choose right insurance plan and benefits. Coverage Period: 01/01/2021 - 12/31/2021 . Hi, Im Kim Keck! The site may also contain non-Medicare related information. Box 7930 Philadelphia, PA 19101-7930 For example: A2A12345678 Here " A2A" is BCBS alpha numeric prefix. You may also want to know: United Healthcare Claims Address Information. Correct BCBS home plan can easily be identified using our BCBS prefix lookup directory. The three-character prefixes listed do not represent an exhaustive listing of prefixes. The most important and easy way to identify BCBS member is his BCBS member ID alpha prefix. Northwest Arizona Employee Benefit Trust (NAEBT) Group # 037461 . To view this file, you may need to install a PDF reader program. BCBS FEP Its indicated with letter R followed by the id number. An incorrect or missing three-character prefix may cause possible delays in the processing of your claims. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. 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. %PDF-1.5 % And to manage such a big network, they divided it into different departments state wise or employer specific. 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. NBT . Amerihealth Caritas Directory Healthcare, Health Insurance in United States of America, Place of Service Codes List Medical Billing. 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: BCBS Alpha Prefix list is useful for both providers and BCBS enrolled members/patients. I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. Benefits and eligibility should be verified for all members prior to rendering services. Call 1-800-388-3193 . Please look for claim filing instructions on the back of the ID card. For more information, contact your Network Provider Consultant or call 406-437-6100. It clarifies a utilization management vendor change for specific members. Member ID cards with no prefix Some member ID cards may not have a prefix. 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. The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. Medicaid It means that BCBS members IDs prefix will must have alphabets and they may or may not have numbers. Member identification numbers beginning with R belong to Federal Employee Program (FEP) and will not have a three-character prefix when filing. 365 0 obj <> endobj Medicare Working or retired, we'll help you every step of the way to find the right plan. Right after completing my degree in 2011, I started my job career as an Accounts Receivable in a medical billing company. Benefits Administration Corporation, Inc. (BACI) 9411 Philadelphia RD. These BCBS prefix may include alpha and numerical characters. BCBS Alpha prefix are the three characters at the start of each BCBS insurance member ID. Choose My Signature. 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 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. 800-676-2583. This step will help you determine if prior authorization may be required for a specific member and service. 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. Blue Cross and Blue Shield of Illinois, P.O. 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. We always make sure to keep BCBS prefix list and BCBS provider phone numbers directory up to date. TPA Name & Address. %%EOF To view this file, you may need to install a PDF reader program. 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. Here Letter R indicates BCBS FEP prefix. 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 Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. BCBS alpha prefix only contains alphabets and each alpha prefix represents different BCBS home plan. 0 Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification).
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