Zbf Bcbs Prefix
Karleen Chura
BCBS is one of the largest healthcare insurance company in US by total members of more than 45 million people. To manage such a big network, BCBS Association divided it into different departments state wise, plan wise and employer specific. To identify correct Blue Cross Blue Shield insurance department, they use 3 characters prefix in the BCBS members plan ID, known as BCBS prefix.
These BCBS prefixes may include both alphabetic and numerical characters. For example: ABC, AQT, TXX, TEA, A2B, 2AB, 2A2, PAS, ZGP, XXU, etc. BCBS prefixes will not only consist of numbers or the digits 0 and 1. This means that BCBS member ID prefixes must include alphabets and may or may not include numbers.
Xceed Billing Solutions motive is to create ease for providers, medical billers, patients and everyone who is involved in revenue cycle process. So, to accomplish our goal, we have listed down the complete BCBS alpha prefix list so that you can easily identify correct BCBS plan. We always make sure to keep BCBS prefix list and BCBS provider phone numbers directory up to date.
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. BCBS Alpha Prefix list is useful for both providers and BCBS enrolled members/patients.
These prefixes may include alpha and numerical characters. For Example: ABC, A2B, 2AB, 2A2 etc. BCBS Prefix will not only have numbers and the digits 0 and 1. It means that BCBS members IDs prefixes will must have alphabets.
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. Also, these BCBS prefixes helps providers and medical billers to reach the correct claims department for claims and benefits inquiry.
Plan Specific prefix are assigned by BCBS to each plan. The first two characters of such BCBS prefix spots member plan and the third character is to identify the type of product in which the BCBS member is enrolled.
BCBS National accounts are employer groups that have outlets/offices in multiple states but they offer limited coverage to their employees. Normally, account specific prefix associates to the employer group name.
PPO stands for Preferred Provider Organization, and Blue Cross Blue Shield (BCBS) is a network of independent health insurance companies operating in the United States. PPO Blue Cross Blue Shield plans offer a type of health insurance coverage that allows members to see any healthcare provider they choose, without a referral, although staying within the network typically results in lower out-of-pocket costs. These plans provide flexibility and a broad range of coverage options, making them popular choices for individuals and families seeking comprehensive healthcare coverage.
Remember to include this prefix as part of the contract number on claims and other records submitted to BCBSM. If a member gives you an ID card with the old prefix of XYO, please ask the member for his or her new ID card that shows the XYL prefix.
Blue Cross and Blue Shield (BCBS) member ID numbers usually begin with a three-character prefix. Prior to April 2018, the prefixes included letters only. To ensure there are enough prefixes to support current and future business needs, the prefixes may now be alphanumeric.
The BlueCard Program links participating health care providers and the independent Blue Cross and Blue Shield Plans across the country and abroad with a single electronic network for claims processing and reimbursement. The program allows participating providers in every state to submit almost all types of claims for out-of-state members to their local Blue Cross and Blue Shield Plan. This program eliminates your need to track money due from multiple Blue Cross and Blue Shield Plans. We process your reimbursement and provide you an Explanation of Payment (EOP).
New Jersey providers that do not participate with Horizon BCBSNJ may also send their claims to us to be submitted to the appropriate plan for processing; however, these providers may not receive reimbursement from their local plan and will still be required to bill the patient.
The BlueCard Program eliminates the need for you to deal with multiple Blue Cross and/or Blue Shield Plans. Horizon BCBSNJ is your single point of contact for claims, payments, adjustments, service and claims-related inquiries.
Once we receive your claims, we will electronically route them to the out-of-state Blue Cross Blue Shield Plan that will process the claim according to each member's contract. They will transmit the claim information to us, which will be included on your Provider Check Voucher. Please make sure that you are submitting the claims with the appropriate alpha prefixes.
Blue Cross and Blue Shield Association providers serve nearly 90 million members nationwide, including almost 20 million national account members. We understand the importance of ensuring easy administration for you, and we want your patients to have a positive experience with each visit.
As a result, we are committed to meeting your needs and expectations by giving you a single point of contact through your local Plan for claims, customer service and provider education-related inquiries.
The BlueCard Program links all Blue Cross and/or Blue Shield (BCBS) Plans allowing for streamlined claims adjudication. Part of the adjudication process often includes requests from other BCBS Plans for additional information and/or medical records to assist in the review and finalization process. BCBS Plans have a formal process that requires those plans to request that information through us. Then, we send one of the following form letters to our providers for the information that is needed. The letter includes a direct point of contact at Horizon BCBSNJ to expedite the process on our end.
Once we have sent out the request, we rely on you, our providers, to expedite the information requested so that the claim processing can be completed. Please assist us in meeting your timeliness expectations by responding to our request and sending the noted information back to the address and individual listed.
Additionally, one item can impact the payment of the entire claim. For example, when a claim is submitted for surgery, and the physician or other health care professional bills with an invalid surgical procedure code and there are multiple surgical procedure codes listed on the claim, the invalid procedure code may impact payment. Therefore, the entire claim has to be pended in order to process it correctly.
NJX is the prefix for the New Jersey State Health Benefits Program's NJ DIRECT plan. NJ DIRECT members have BlueCard benefits when receiving services outside of New Jersey. As a Horizon BCBSNJ participating physician or other health care professional, when rendering services in New Jersey to a NJ DIRECT member, file claims with Horizon BCBSNJ as instructed on the member's ID card.
If you are treating an Empire BCBS member and you contract with Horizon BCBSNJ and Empire BCBS, file the member's claim directly with Empire BCBS. If you are treating an Empire BCBS member and services are rendered in New Jersey and you contract only with Horizon BCBSNJ, file the member's claim with Horizon BCBSNJ for BlueCard claim processing.
If you are treating an Independence Blue Cross member and you contract with Horizon BCBSNJ and Independence Blue Cross, file the member's claim directly with Independence Blue Cross. If you are treating an Independence Blue Cross member and services are rendered in New Jersey and you contract only with Horizon BCBSNJ, file the member's claim with Horizon BCBSNJ for BlueCard claim processing. For AmeriHealth and Keystone, refer to the member's ID card for the appropriate claims filing instructions.
Unfortunately, at this time, an all-inclusive list of radiology authorization contact numbers is not available. We ask that you call 1-800-676-BLUE (2583) for specific member eligibility and benefit information. A knowledgeable representative will assist you.
This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not the Health Insurance Marketplace website. This website does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association
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