Modifications we make to your contract or to our policy or procedures are not subject to the appeal process unless we made it in violation of your contract or the law. To help you move from paper to electronic claims, follow these steps: Electronic claims can be sent when we are the secondary insurance payer. Level II appeals must be submitted in writing within 30 calendar days of the Level I appeal decision and can only pertain to a billing issue. Availity is solely responsible for its products and services. The most commonly occurring codes and messages are listed below. AAT Anthem Blue Cross of California When the member completes and returns the IQ form to Calypso Subrogation department, a representative will screen the document to determine if another party is responsible for processing claims prior to the health carrier stepping in. Interest less than A required waiting period must pass before we can provide benefits for this service. We require that you verify the information about your practice and the networks you participate in at least every 90 days. PO Box 1106. CVY BCBS of Louisiana If you have questions regarding the enrollment process, contact Availity Client Services at 1.800.AVAILITY (282.4548). CZW BCBS of North Carolina From there, you will be directed to a new site; at this site, enter in your login information. AGG Anthem BCBS of Ohio ADJ Anthem BCBS of Missouri 0000001762 00000 n Claims & payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. Care Management Programs. Once the IQ is returned, all claims are reviewed and processed based on the information supplied. Alaska contracted and non-contracted Call customer service and web support at 800-607-0546 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time. Complaints received beyond the 365-day timeframe will not be reviewed and the appeals rights pertaining to the issue will be exhausted. For other language assistance or translation services, please call the customer service number for . 1-800-962-2731. . ), claims will be processed accordingly and under the terms of our subscriber's contract. 0000015026 00000 n Get immediate member information by phone or fax . 3. Use only red CMS-1500 forms (no photocopied forms). Mental Health/Substance Use Disorder Precertification. View your credentialing status in Payer Spaces on Availity Essentials. AEF BCBS of IL When the conversion factor is multiplied by the total RVUs, it will yield the reimbursement rate for the specific service (or code). DAC BCBS of Tennessee CWJ BCBS of Alabama Retirees and PEBB Continuation Coverage members:Phone: 1 (800) 200-1004TRS: 711Business hours: Monday through Friday 8 a.m. to 4:30 p.m. (Pacific). Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. ), Email all EDI questions to: EDIRequests@accesstpa.com. Refer to your contract for further claims submission information. If member does not return the call, claims will be denied until information is received. The protection of your privacy will be governed by the privacy policy of that site. DJC Anthem BCBS of Ohio AAK Anthem Blue Cross of California There is no charge to healthcare providers who submit electronic claims directly to us. We're ready. CZZ Highmark BCBS AGC BCBS Kansas City ADQ Independence Blue Cross Regence Blue-Cross Blue-Shield: YAM-Unallocated/Not Assigned: YAN-Unallocated/Not Assigned: YAO-Unallocated/Not Assigned: YAP: Minnesota: 1-877-764-8724 Email Us. ABG BCBS of Georgia Verify benefits or eligibility for BlueCard members. View the instructions for verifying your information and notifying us of changes. DJG Anthem BCBS of Ohio account number and claim number handy when you call. Make sure you have your Member ID card handy when you call us. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. ADL Anthem BCBS Kentucky Before implement anything please do your own research. CVP Anthem BCBS of Ohio 0000006371 00000 n AIH Anthem Blue Cross of California 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. Find helpful phone, fax and email information for assistance. 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. AHQ Anthem BCBS of Ohio to 6:00 PM PT or log in to your RGA account and submit an electronic request. You can submit claims daily, weekly, or monthly. When processing claims, the system: Actual payment is subject to our fee schedule and payment policies; to a members eligibility, coverage, and benefit limits at the time of service; and to claims adjudication edits common to the industry. The claim(s) will suspend and a processor will review to determine whether to send an Incident Questionnaire (IQ) to the member. 0000055309 00000 n If you are unsure how to submit secondary claims electronically, contact your practice management system vendor or contact an EDI representative at 800-435-2715. Premera Blue Cross ), Covered under the provisions of motor vehicle medical policy, personal injury protection (PIP), medical payments (Medpay), Uninsured (UIM) and/or underinsured (UM) motorist or other similar coverage (e.g., homeowners, commercial medical premises), Checks for eligibility of the member listed on the claim, Compares the services provided on the claim to the benefits in the subscribers contract, Applies industry standard claim edits and applicable payment policy criteria, Applies to professional and facility claims. AHW BCBS of MA Be on . If you require a written refund request before mailing the overpayment, contact Calypso directly at 800-364-2991. Use the following codes: In the Original.Ref.Co segment of box 22 enter the original claim number. AEA BCBS of Texas This is worthwhile to avoid selecting the alpha prefix randomly. Blue-Cross Blue-Shield of Illinois. CZE Anthem Blue Cross of California 6:00 AM - 5:00 PM ASTFax: 877-239-3390 (Claims and Customer Service)Fax: 877-202-3149 (Member Appeals only)Fax: 866-948-8823 (FEP Care ** When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the members card. . As members renew or enroll their individual or group contracts for health care coverage in 2016, they will be presented with a new Highmark branded ID card. We do not request refunds for overpayments less than $25, but you may submit these voluntarily. COB information is allowed when the primary coverage is with a commercial payer; this generally excludes Medicare and FEP. If submitting a corrected claim on paper, remember to: Obtain Corrected Claim - Standard Cover Sheets at onehealthport.com in the administration simplification claims processing section, or under Forms on our provider website. color, national origin, age, disability, sex, gender identity, or sexual orientation. CYP BCBS of IL Regence Uniform Medical Plan Vision Claim Form - An ERISA Section 502 (a) prepare can be reported in many different methods. We can process the claim after we receive that information. ADE BCBS of IL Included with the interest voucher is a summary report detailing ADA Anthem Blue Cross of California View the toolkit Claims submission Completion of the credentialing process takes 30-60 days. Open 24 hours a day, 7 days a week. For Example: XYZ123456789. Regence BlueShield serves select counties in the state of Washington and is an independent licensee of the Blue Cross and Blue Shield Association. AEZ Wellmark BCBS Iowa/South Dakota If member returns the call and the information is obtained, claims will be processed. AFP Anthem BCBS of Ohio Box 91102 Once the submission is complete and if the issue is billing related, we review the request and issue a decision within 30 days, along with your right to submit a Level II Appeal if you are not satisfied with the outcome. Boise, ID 83707. For more information, view our privacy policy. They must be sent hard copy. This claim was paid previously to the provider or applied to the member's deductible. If you are a clinic or hospital-based physician or other qualified healthcare provider, use a CMS-1500 (02-12) form for claims for professional services and supplies related to: This includes claims for outpatient services and services performed by a hospital-based physician or other qualified healthcare provider. Click on the Submit a Preauthorization Request link. CYN Highmark BCBS 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. Were ready. To find a health care provider in the KingCare network, go to Find a doctor and sign in to your Regence BlueShield account. 0000004716 00000 n We use cookies on this website to give you the best experience and measure website usage. If the information received indicates an on-the-job illness or injury, both the member and physician/provider will receive a denial that states the Premera contract excludes work-related conditions. Money was posted to your account during the payment cycle. The following are examples of ID numbers with the alpha prefix highlighted: Note : Guest members do not have an alpha prefix. AEV Keystone Health Plan East (IBC) Friday 6:00 AM. 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). If we need additional information for subrogation determine to pay or deny, the IQ will either be sent back to the member requesting the information, or subrogation will make two calls within five days of receiving the IQ. trailer AFO Arkanasa We will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. AEK Independence Blue Cross ACR Anthem Blue Cross of California The plan doesn't cover cosmetic services. Practitioners who arent credentialed may have their claims returned until they submit a complete credentialing application. Our Customer Care lines will re-open at 6 AM PT the following business day. Claims Address. BCBS Federal Phone Number; Ambetter Claims address and Phone Number; Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit; Kaiser Permanente Phone Number . Contact Us. If it is, call the BlueCard Eligibility line 800-676-BLUE (2583) to verify the ID number. ADI Anthem Blue Cross of California By continuing to use this website, you consent to these cookies. To help your office complete year-end accounting, each December we'll issue you a check for the accrued interest we owe you, even if the amount is below the You must request mediation in writing within 30 days after receiving the Level II appeals decision on a billing dispute. Diabetes. AGY BCBS of South Carolina This means that you may see cards with ID numbers between six and 14 numbers/letters following the alpha prefix. We are now processing credentialing applications submitted on or before March 6, 2023. An overpayment was recorded during the payment cycle. you will need to contact Regence to update your account to ensure your claim processes correctly and timely. EMPIRE BCBS Decides the pre certification requirements based on the prefix id.
