regence claims address

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. Italiano | All our content are education purpose only. If there are no court decrees, the plan of the parent with custody is primary. If it is, call the BlueCard Eligibility line 800-676-BLUE (2583) to verify the ID number. Box 33 Enter the contract name of physician or provider who performed the service. No pre-authorization for COVID-19 vaccinations, testing and treatment, No member cost shares for COVID-19 vaccinations, testing and treatment. Uniform Medical Plan - Benefits 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. Mail a completed Overpayment Notification form (found in our online library under Forms) and mark the box requesting a voucher deduction to recover the overpayment on future claim payments. CZY BCBS of North Carolina BCBS Prefix List 2021 - Alpha. Box 3004 Naperville, IL 60566-9747. We will notify you once your application has been approved or if additional information is needed. Claim Forms; Get to know your member ID card. Mental Health/Substance Use Disorder Precertification. We can process the claim after we receive that information. 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 will continue to update this section of our website to make sure you have the latest COVID-19-related information and helpful resources. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. We will notify you once your application has been approved or if additional information is needed. 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. Please reach out and we would do the investigation and remove the article. To pay this claim, we needed to review information from the provider. 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. Example: 001-916-635-7373. We'll coordinate the benefits of the members plan with those of other plans to make certain that the total payments from all plans aren't more than the total allowable expenses. The claim(s) will suspend and a processor will review to determine whether to send an Incident Questionnaire (IQ) to the member. The employer group name is usually associated with the alpha prefix of the account specific health insurance type. We'll notify you in writing or by telephone when you have successfully completed the test phase. Designed by Elegant Themes | Powered by WordPress. Guardian Employees . By continuing to use this website, you consent to these cookies. ABI BCBS Minnesota | . You can also call using Skype. Please follow BCBS alpha prefixes list and claim submission address - Updated list 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). To submit a Level I, Level II or Mediation Appeal (see above to submit a Complaint), send complete documentation to: Physician and Provider Appeals Here are examples: A Level I Appeal must be submitted with complete supporting documentation that includes all of the following: Incomplete appeal submissions are returned to the sender with a letter requesting information for review. Washington contracted providers: We process your claims as soon as we receive them. 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. They have Coordination of Benefits when we are the secondary carrier on the claim. Complaints received beyond the 365-day timeframe will not be reviewed and the appeals rights pertaining to the issue will be exhausted. 0000005570 00000 n CUZ Anthem BCBS of Ohio Fraud or abuse You can remain anonymous. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. The mediator's fees are shared equally between the parties. Sometimes an office returns a check to us that represents multiple claims because a portion (see Threshold below) of the payment may be incorrect. A detailed description of the disputed issue, All evidence offered by you in support of your position including medical records, A description of the resolution you are requesting. 0000001240 00000 n ABZ Carefirst BCBS Maryland The claim will be reprocessed and reflected on the payment voucher. For more information about RBRVS methodology visit the CMS website. Send to Regence Blue Shield in accordance with the terms of your provider contract with Regence. Tennessee. It is only after we determine a members eligibility or coverage that payment policies and edits are applied. The NPI replaces all proprietary (payer-issued) provider identifiers, including Medicare ID numbers (UPINs). Service not a benefit of subscriber's contract, Investigational or experimental procedure. the instructions to determine where to send claims or correspondence. . The provider appeals process does not apply to FEP, BlueCard Home Claims, Medicare Supplement plans, or Medicare Advantage plans. A members ID number includes the alpha prefix in the first three positions and all subsequent characters between 6 and 14 numbers or letters up to 17 characters total. The provider needs to submit itemized charges to us. This standard is called the "Birthday Rule.". The SORA is generated when one of the following occurs during a payment cycle: Physicians and providers have the right to appeal certain actions of ours. AFA Anthem BCBS of Virginia CYN Highmark BCBS Unclean claims will begin to or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. . Use the following codes: In the Original.Ref.Co segment of box 22 enter the original claim number. A Statement of Overpayment Recoveries (SORA) is included with an Explanation of Payment (EOP) when we've processed an overpayment recovery activity within a payment cycle. ACU Anthem Blue Cross of California ADJ Anthem BCBS of Missouri AHE Empire BCBS Regence Blue Shield of Idaho - FEPPO Box 30270Salt Lake City, UT 84131-0207. These charges are included in the main anesthesia service. Send us other carrier's explanation of benefits. DHA Excellus BCBS Utica P.O. That's why Anthem uses Availity, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to healthcare professionals. We forwarded this claim to the member's home plan for processing. When you go to this page, you should see a dialog box that asks for your ZIP code. PDF MEDICAL CLAIM FORM - Washington We use cookies on this website to give you the best experience and measure website usage. 24/7 Nurse Line: 800-267-6729. This traditional, broad network includes a wide variety of doctors and specialists across the United States. P.O. complies with applicable Federal and Washington state civil rights laws, Determine the county where the service was performed* (see exceptions below). Regence Bluecross Blueshield of Oregon - Dun & Bradstreet If you need more information about the NPI mandate, Medicare timelines, and/or the enumeration process, visit the CMS website. Church Street Station. 0000055776 00000 n Claims & payment - Regence Call Customer Service and choose the Pharmacy option. AFM BCBS Minnesota BlueCard/FEP Lookup | Blue Cross of Idaho - bcidaho.com AHI BCBS of Rhode Island Karen Lyons, APR Sr. Director, Public Relations 612.777.5742 klyons@primetherapeutics.com. We can't process this claim because we haven't received your response to our request for information. Oregon - Blue Cross and Blue Shield's Federal Employee Program Both for dental and medical professional services, promises forms can be found. QMC Retail OFF Exchange AGE Independence Blue Cross Calypso, our affiliate, processes refunds and overpayment requests. Every user of BCBS health insurance is assigned an alpha prefix that contains three letters. ** Verify with the member that the ID number on the card is not his/her Social Security Number. Box 21267 M/S S518 Seattle, WA 98111-3267 Claims appeals, balance billing or pricing disputes The process for submitting an appeal depends on your issue. . 2023 Regence BlueShield. As a beginner to alpha prefix of BCBS at this time, you like to know about the role of the alpha prefix and how to use this alpha prefix properly. ABY Carefirst BCBS Maryland This alpha prefix of BCBS plays the major role behind the proper way to claim the health insurance plan without delay and difficulty. . When Calypso identifies an overpayment, they mail an Overpayment Notification letter with a request for the overpaid amount. H\@F. AFZ Anthem Blue Cross of California Contact Us. As a KingCare member, your care is covered at a higher level inside the network, but the plan also pays a smaller amount toward your bill if you see a doctor outside of the KingCare PPO network. . AGB Excellus BCBS Be sure to submit a paper CMS-1500 claim form or electronic 837P claim form that is complete and accurately filled out. Units shown in box 24G of the CMS-1500 form. 0000004829 00000 n 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). An overpayment was recorded during the payment cycle. Get immediate member information by phone or fax . Money was posted to your account during the payment cycle. Blue Cross and Blue Shield of Illinois P.O. *Follow instructions on these ID cards to verify eligibility, submit claims and obtain health plan contact information. DJU Carefirst BCBS Maryland Before discussing member claim information, the Customer Service representative must verify the identity of the caller. | Regence Health Plans, Prime Therapeutics study shows significant 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). Dont write or stamp extra information on the form. Always refer to the online branded versions of our payment policies to ensure the most current and accurate information. 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. ADG Anthem BCBS of Ohio Your health care provider will require that you full and distribute these declare paperwork to UnitedHealthcare. You must request mediation in writing within 30 days after receiving the Level II appeals decision on a billing dispute. 598 0 obj <>stream Learn how to contact your local Blue Cross and Blue Shield company, as well as other key areas. AFK Empire BCBS ** A local network identifier, (for example, BlueMark) AIA BCBS of Texas 0000001921 00000 n BCBS Provider Phone Number. When a Medicare patient received services that Medicare specifically requires to be submitted on separate claim forms, this one claim requirement will not apply. Claims determinationsThe plan will notify you of action taken on a claim within 30 days of the plan receiving it. BCBS Prefix List 2023 - Alpha Prefix and Alpha Number Prefix Lookup When dependent children are double-covered by divorced parents, coverage depends on any court decrees. It identifies the members Blue Cross Blue Shield company or national account in order to properly route the claim. This is worthwhile to avoid selecting the alpha prefix randomly. 0000010898 00000 n ACR Anthem Blue Cross of California Check out the changes and updates to our plan in 2023. AEJ Horizon BCBS of New Jersey PO Box 52080 DJQ Anthem Blue Cross of California Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Ting Vit | 0000006371 00000 n Select the area of the map that matches the color of the county where the service was performed. Remember to include the leading three-character prefix and enter it in the appropriate field on the claim form. We send the member a questionnaire requesting information to determine if benefits are available. ABL BCBS of IL Care Management Programs. Interested in joining our provider network? Tricare Phone Number and Claim Address; Molina Healthcare Phone Number claims address of Medicare and Medicaid. The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. The charges for this service have been combined into the primary procedure based on the provider's contract. All of our contracts exclude coverage for care covered under the Workers' Compensation Act. BCBS Company. Access fee schedules. Claims & payment Learn how to identify our members' coverage, easily submit claims and receive payment for services and supplies. January 19, 2022 by tamble. 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. Ideally, we'd like you to submit claims within 60 calendar days of the covered services, but no later than 365 calendar days from the date of submission. Saturday 7 a.m. to 8 p.m.; Sunday 7 a.m. to 7 p.m. (Pacific)Calling from outside the US: Dial exit code of your country (typically 00) plus the country code (1 for USA), then the area code (916), then the seven-digit US local phone number 635-7373. Complete the enrollment form on the following page to receive 835 ERA files from Regence payers . Access eContracting to view and sign agreement documents. For other language assistance or translation services, please call the customer service number for your local Blue Cross and Blue Shield company. Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL Examples: medical doctor, osteopath, optometrist, chiropractor, physical therapist, audiologist, independent laboratory, nurse practitioner, durable They can use such copies in different situations and get the complete support on time as awaited. QMB SG ON Exchange CUQ Blue Shield of California AEV Keystone Health Plan East (IBC) LAB. Bill all original lines-not including all of the original lines will cause the claim to be rejected. AFS Blue Shield of California 0000018816 00000 n Provider: please send us the member's lab results for this claim. Included with the interest voucher is a summary report detailing $25 will continue to accrue until it reaches that threshold or until December of each year. 0000015111 00000 n trailer ACD BCBS of Michigan If the Level II appeal is timely and complete, the appeal will be reviewed. 553 0 obj <> endobj Regence Uniform Medical Plan Vision Claim Form Note: When submitting an email inquiry, please include your tax identification number (TIN) and/or Organizational NPI number. You can also submit claims via mail to our claims address P.O. CWQ Anthem BCBS of Ohio Deutsch | 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. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. DJN BCBS Minnesota AAQ Anthem BCBS of Ohio Regence BlueShield of Idaho | Regence In some contracts, we use a RBRVS methodology, developed by CMS, to calculate its fee-for-service fee schedule. Insurance Denial Claim Appeal Guidelines. 1 (877) 878-2273 ABU BCBS Minnesota EMPIRE BCBS Decides the pre certification requirements based on the prefix id. Blue Cross and Blue Shield of Illinois (BCBSIL) members ID cards in the BlueCare Direct and Blue Choice Preferred PPO plans have been updated. Once the claim is found, you can click on original EOP view to pull up this information. 0000018886 00000 n Find helpful phone, fax and email information for assistance. 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. account number and claim number handy when you call. When completing the CMS-1500 form, note the following: HIPAA's Administration Simplification provision requires a standard unique identifier for each covered healthcare provider (those that transmit healthcare information in an electronic form in connection with HIPAA-standard claim transactions). | you will need to contact Regence to update your account to ensure your claim processes correctly and timely. Home | Northwest Carpenters Trusts 24/7 anonymous hotline: 1 (800) 323-1693 KingCareSMuses a preferred provider organization (PPO) for its network. Only appeals received within this period will be accepted for review. See the following pages for an explanation of the EOP fields and a description of codes and messages. AGR Anthem BCBS of Colorado AEQ BCBS of Michigan ABN Anthem BCBS of Virginia PO Box 1106. Franais | Regence You will need special software to send insurance claims electronically. DBT BCBS of Michigan Occasionally, you may see identification cards from members residing abroad or foreign Blue Plan members. endstream endobj 554 0 obj <>/Metadata 28 0 R/Pages 27 0 R/StructTreeRoot 30 0 R/Type/Catalog/ViewerPreferences<>>> endobj 555 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 203>>/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 556 0 obj <> endobj 557 0 obj <> endobj 558 0 obj <> endobj 559 0 obj <> endobj 560 0 obj <> endobj 561 0 obj <> endobj 562 0 obj [591 0 R] endobj 563 0 obj <>stream https://www.bcnepa.com/Providers/providerrelations/ReferenceGuides/AlphaPrefixList.pdf. VOG NY MA PPO MediBlue PPO Plus 1-866-395-5175 H3342, Premera Blue Cross & The Regence Group Common Alpha Plan Prefixes Last updated: 09/01/2016, Premera Blue Cross & Premera Blue Cross/NASCO Prefixes. If we do not receive a response within the specified period, the claim(s) is denied pending further information. We're ready. ADD Anthem BCBS of Ohio CZK Anthem BCBS of Virginia Members and Providers: 1-800-395-1616 Email Us. Visit the Regence provider website, regence.com to learn more about: Claims and payment: Appeals. claims status, . Call 1 (855) 522-8894. To send an electronic claim, use the Availity clearinghouse with payer ID RGA01. If we processed the original claim incorrectly, you do not need to rebill. Contact Us - Uprise Health We can process the claim after we receive that information. AHK Anthem Blue Cross of California Claims Submission Map | FEP | Premera Blue Cross You may like to substitute any prefix of BCBS with an existing BCBS. Oromoo | They will be satisfied when they properly use this insurance plan and fulfil overall requirements on the prompt assistance for claiming the insurance. ), claims will be processed accordingly and under the terms of our subscriber's contract. How do I determine if a diagnosis or procedure code needs preauthorization? Bellevue, WA 98004, Terms of Use | Privacy| Disclosure Notice Patient Protection Surprise Billing, An Independent Licensee of the Blue Cross Blue Shield Association Serving Select Counties in Washington. AGX Anthem BCBS of Virginia Only a member can request a Level I or Level II Appeal for a non-billing issue, unless the member has completed a release to allow the provider to act as their Representative. To find a health care provider in the KingCare network, go to Find a doctor and sign in to your Regence BlueShield account. ADT BCBS Minnesota ACN BCBS of IL 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. ), 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. Our medical staff reviewed this claim and determined that this admission doesn't meet the criteria for medical necessity. P | Email: Contact Regence. YUV SG ON Exchange You can submit a complaint about one of our actions (verbally or in writing) to one of our employees. 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). DJY Anthem BCBS of Ohio Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Claim edits in place will identify those services previously billed and bundle ALL services on to a single For general inquiries and questions about the Service Benefit Plan, our overseas and pharmacy coverage or fraud assistance, you can call us toll-free nationwide. 1-800-676-BLUE (2583) (toll free) Blueline voice response unit. CZM Highmark BCBS Mail this claim to: Regence BlueShieldPO Box 1106Lewiston, Idaho 83501 Or Fax claim to: (888) 606-6582 FORM PD020-WA Page 2 of 3 (Eff. ), 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. Contact Us | FEP | Premera Blue Cross

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