Get your online template and fill it in using progressive features. Patient Eligibility and Benefits; Pre-Service Review; Pre-Service Review for Out-of-Area Members . (You can fill the form in electronically or complete it by hand.). All rights reserved. If you want to stay on Blue Cross' website, click "Cancel.". In most cases, you can prevent a retroactive denial by paying your premiums on time and/or by promptly notifying the plan or, if applicable, the marketplace of changes in your eligibility status for the plan. An employee or dependent who loses coverage under Medicaid or a State Children's. Blue Cross and Blue Shield of Alabama Provider Directory > Claims Issues > or call 877-231-7239 or 205-220-6899 for eSolutions New Directions AL_ProviderRelations@ndbh.com or call 888-611-6285 < Back myBlueCross Member Login Contact Us: 1-888-543-9212 (TTY:711) myBlueCross Member Login Call 1-888-543-9212 TTY 711 . } Don't have a User ID? if (userAction === 'onclick') { USLegal received the following as compared to 9 other form sites. You can reach us at the following number: If you are or believe you may be experiencing a medical emergency,please dial 911 for emergency services.If you or a family member needs immediate assistance, please contact one of our representatives at 800-528-5763. $.ajax({ With Blue Cross and Blue Shield of Alabama, all of our dental plans include regular dental exams, x-ray and routine cleaning - at no extra cost. Provider. Thank you for your interest in our Short Term Plan. Features expanded pediatric benefits for children up to the end of the month in which the member turns 19. at 1-855-488-2515 or click the "Get Started" link to compare your plans today. var fromUrl =window.location.host; Address: CHIP P.O. If you use a provider outside of our network, you'll need to complete and file a claim form to be reimbursed. } else { Precertification also does not mean that we have been paid all monies necessary for coverage to be in force on the date that services or supplies are rendered. The protection of your privacy will be governed by the privacy policy of that site. Applicable FARS/DFARS apply. Blue Cross and Blue Shield of Alabama has an established appeals process for providers and physicians. 450 Riverchase Jun 4, 2012 Payers Transitioned to 5010 As of 6/4/2012 Below is a list of the Use professional pre-built templates to fill in and sign documents online faster. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Some information on our siteis secure; log in to ensure youre seeingall the news. CDT codes, descriptions and data copyright 2022 American Dental Association. Call 1-855-890-7416, 8 a.m. - 8 p.m. Central Time, Monday through Friday. Your member ID card is your key to using your medical plan benefits. Include the date to the document using the. Box 3686, Scranton . Overseas members must file claim forms for any covered medical or pharmacy servicesreceived outside of the United States. LLC, Internet You can use 3 available choices; typing, drawing, or uploading one. Register With Form - AFP Annual Conference - Association For - An17 Afponline, Identity Provider Appeals Blue Cross and Blue Shield of Alabama has an established appeals process for providers and physicians. Submit a separate claim for each patient. $129 /month. It also tells you how much has been credited toward any required deductible and out-of-pocket maximums. If your provider does not file your claim for you, you can call our Customer Service Department at the number on the back of your ID card and ask for a claim form. To determine your premium, call us at 1-855-488-2515 or click the "Get Started" link to compare your plans today. Ifyou believe that this page should betaken down, please follow our DMCA take down process, Ensure the security ofyour data and transactions, Dental Claim Form - Blue Cross And Blue Shield Of Alabama - Bcbsal. You can use our interactive search to find your local Blue Cross Blue Shield Company's website. Rev 3/2007 2. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. Heres everything you need to know about it. Applicable FARS/DFARS apply. Submit a separate claim for each member. 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. Claims Administrator **Dental Blue Plus is a Health Insurance Marketplace plan. If your drug is not covered and you think it should be, you may ask us to make an exception to the drug coverage rules by calling the Customer Service Department number on the back of your ID card. USLegal has been awarded the TopTenREVIEWS Gold Award 9 years in a row as the most comprehensive and helpful online legal forms services on the market today. gives you access to exams, X-rays and routine cleaningsat no (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). As a CHA representative, I agree to the payment terms and conditions of Blue Cross and Blue Shield of Alabama and will not collect any checking account, debit card or credit card information on behalf of the consumer for the purchase of health or dental insurance. Our representatives can answer your questions and help you navigate these choices. Regular Dental Program P O Box 830389 Birmingham, AL 35283-0389 Dental Expense Claim An Independent Licensee of the Blue Cross and Blue Shield Association TO BE COMPLETED BY SUBSCRIBER 1. Be sure the data you add to the Dental Claim Form - Blue Cross And Blue Shield Of Alabama - Bcbsal is up-to-date and accurate. A retroactive denial is the reversal of a previously paid claim. } This function gets loaded when everything, including the portlets, is on Patient. Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us. The plan will only pay for care that is medically necessary and not investigational, as determined by us. Quality Care That's Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find.BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Attorney, Terms of Using an electronic vendor approvedwith Blue Cross and Blue Shield of Alabama, submit an electronic claim using a valid Tax ID, Individual NPI and Organizational NPI. View the latest providernews. Claim Statements Reimbursements Contract and Dependent Information Other Insurance Coverage Deductible & Out of Pocket Costs View Benefits and Coverage Resources Review and Pay my Bill ID Cards Forms and Materials Covered Immunizations Health Insurance Basics Policies and Guidelines Preventive Services Caregiver Resources Only available through. Forms 10/10, Features Set 10/10, Ease of Use 10/10, Customer Service 10/10. Generally, if precertification is required and not obtained, no benefits will be payable under the plan. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. $('#chat-available').show(); $42 /month. Questions? Claim forms must be submitted to: Blue Cross and Blue Shield of Alabama 450 Riverchase Parkway East Birmingham, Alabama 35244-2858 Grace periods and claims pending policies during the grace period Enroll as a Blue Cross provider, update provider information, or begin the credentialing/recredentialing process. For general inquiries, please call Blue Cross Blue Shield FEP Dental Customer Service at 1-855-504-BLUE (2583), 8 a.m. - 8 p.m. EST Monday - Friday (TTY 711) You can also submit an online inquiry regarding claims; ID cards; website assistance; grievance or appeal; or fraud, waste, and abuse. Box 303017 Montgomery, AL 36130-3017. A primary plan is one whose benefits for a person's healthcare coverage must be determined first without taking the existence of any other plan into consideration. CDT codes, descriptions and data copyright 2022 American Dental Association. You can also find our claim forms on our website at: Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. Follow the simple instructions below: The days of distressing complex legal and tax forms have ended. Get Started Include proof that you paid a Medicare Part B premium. CDT codes, descriptions and data copyright 2022 American Dental Association. I have reviewed the following treatment plan. Download the Medicare Reimbursement Account (MRA) Pay Me Back claim form: Complete the form following the instructions on the front. English Espaol. Blue Cross Blue Shield of Oregon -Regence FEP Claims TLW13 USA Blue Cross Blue Shield of Rhode Island: CB870 W: USA Emergency services are not covered out-of-network under our dental plans. As an Alfa representative, I agree to the payment terms and conditions of Blue Cross and Blue Shield of Alabama and will not collect any checking account, debit card or credit card information on behalf of the consumer for the purchase of health or dental insurance. Expenses will be applied against your Plan of Care and reimbursed accordingly. Are you reporting a new case? Blue Plus **. Attach pharmacy receipts for covered prescriptions. HealthEquity is our business associate and is an independent company that provides account-based plan services to Blue Cross. From October 1 through February 14, we are available 7 days a week. Make sure your documents include the five following pieces of information as required by the IRS: Provider name (which is Medicare in this case), You can fax the form, along with proof that you paid a Medicare Part B premium, to, You can upload the form through the EZ Receipts mobile app, available at the. Blue Cross Blue Shield of Alabama CBAL1: W USA: Blue Cross Blue Shield of Alaska 47570: USA . services, For Small To save time and incorrect billing process you can check the below table for the insurance numbers along with the respective states of the BCBS. Find your plan. Download your FREE dental guide to learn more about Find your smile. contact your local Blue Cross and Blue Shield company. Three forms are also available to aid providers in preparing an appeal request. To ask for a formal decision about the coverage if you disagree, print and complete the appropriate form below and fax it to 1-800-693-6703 or mail to Prime Therapeutics LLC, Attention: Part D Appeals Department, 1305 Corporate Center Dr. How to File a Claim Call Preferred Long-Term Care (LTC) Customer Service (1-888-331-4188) to complete the Claims Intake Form over the telephone. Ensures that a website is free of malware attacks. . You can file your expenses for reimbursement as frequently as you want. Use this form to submit a health benefit claim for services that are covered under the Blue Cross and Blue Shield Service Benefit Plan. You can view your personal EOBs through your MyBlue account. With US Legal Forms the entire process of completing official documents is anxiety-free. //show the chat available image A Qualified Health Plan is an insurance plan that has been certified by the Health Insurance Marketplace and provides essential health benefits, follows established limits on cost sharing and meets other requirements under the Affordable Care Act. A Blue Cross representative from LifePlans will contact you to discuss your initial needs and to clarify any questions you have about your policy. Blue Cross Community Health Plans, c/o Provider Services, P.O. Start now! 2023, Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. the range of plans available toyou. 13. Information contained in the external sites is not endorsed by BCBSAL. Need to submit a claim? Thank you for your interest in our Short Term Plan. HealthEquity has agreed to follow Blue Cross' privacy and security policies regarding the confidentiality and protection of your personal health information. Someone will get back to you within two business days. Patient & Claim. Submit a separate claim for each patient. Include the date to the document using the Date function. HealthEquity has agreed to follow Blue Cross' privacy and security policies regarding the confidentiality and protection of your personal health information. If you receive services from an out-of-network provider, these services may not be covered at all under the plan. the page. What is the fax number for BCBS Alabama appeals? To determine your premium, call us Mail original claims to the appropriate address as noted below. When you receive services from an in-network provider, your provider will generally file claims for you. This link takes you to another website. As an Alabama Health Guidance representative, I agree to the payment terms and conditions of Blue Cross and Blue Shield of Alabama and will not collect any checking account, debit card or credit card information on behalf of the consumer for the purchase of health or dental insurance. Lastly mail the completed claim form to the address provided. Please attach any additional information and/or medical records at the time of filing the appeal for consideration. By clicking "Next", you are acknowledging that you would like to submit your application otherwise, click "Cancel". { For more information, view our privacy policy. Call 1-855-488-2515. You may access the Nondiscrimination and Accessibility notice, Navigate & Connect: Simplifying access to behavioral healthcare. An assessment will be scheduled and performed by a Blue Cross representative to determine if your situation and health needs meet claims benefit eligibility. 2023 Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue ShieldAssociation. Call the IVR: 205-220-6765. Thank you for your interest in our Short Term Plan. 3. If the out-of-network services are covered, in most cases, you will have to pay significantly more than what you would pay an in-network provider because of lower benefit levels and higher cost sharing. * Sign up today and get a plan that's accepted by over 1,700 A secondary plan is one which takes into consideration the benefits of the primary plan before determining benefits available under its plan. As an Alfa representative, I agree to the payment terms and conditions of Blue Cross and Blue Shield of Alabama and will not collect any checking account, debit card or credit card information on behalf of the consumer for the purchase of health or dental insurance. COB provisions determine which plan is primary and which is secondary. Health . An EOB is an outline of what services you received from a provider and how your benefits were applied to cover those services. 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. When we receive an electronic claim, you will automatically be set up as an out-of-state provider in our system and can register to use our provider website, ProviderAccess: Once . We reference sites that we think might be useful or of interest to you, but we are not responsible for the content or privacy practices used by other site owners. Provider Phone Numbers PEEHIP P.O. */ { 2023, Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. If you believe you believe you have overpaid your premium due to our overbilling, please contact us by calling the Customer Service Department number on the back of your ID card. Child up to age 19. Some information on our site is secure; log in to ensure you're seeing all the news. EDI enrollment is NOT required for submission of electronic claims. To continue to the HealthEquity website, click "Accept." What is the fax number for BCBS of Alabama claims? Family. The route you should take depends on your individual healthcare needs and financial situation. We use cookies to improve security, personalize the user experience, enhance our marketing activities (including cooperating with our marketing partners) and for other business use. If you have questions, please contact your local Blue Cross and Blue Shield company. ); Experience a faster way to fill out and sign forms on the web. Phone Numbers. Use this form to submit a claim to be reimbursed for paying Medicare Part B premiums. If you want to stay on the Blue Cross website, click "Cancel.". ProviderAccess Provider News View the latest provider news. If you do not know this information, please contact us at 205-220-7725 or fax your request to 205-220-6354. The first column represents the states of the US and the second column is the insurance name and the Third column represents the Phone number. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. This link takes you to another website. #1 Internet-trusted security seal. Note: If you are a Blue Cross and Blue Shield of Alabama customer and need to reach us by phone, please use the telephone number (s) on the back of your ID card. Features expanded pediatric benefits for children up to the end of the month in which the member turns 19. checkChatAvailability('onload'); The case number, contract number and/or accident date you've entered does not match our records. ALL Kids. Providing us with your name and email address allows us to contactyou. If you receive out-of-network services for a medical emergency in the emergency room of a hospital, those services will be paid at the applicable in-network coinsurance amounts for benefits described in your benefit booklet, but subject to the out-of-network calendar year deductible.For emergency services for medical emergencies provided within the emergency room department of an out-of-network hospital, the allowed amount will be determined in accordance with the Affordable Care Act. Patient Consent Form for Provider Submitted Appeals View PDF. Node:bclrprvappp1001.corp.bcbsal.org:8080, Pre-Service Review for Out-of-Area Members, PRO-81 Professional Reimbursement Appeal Form, PRO-82 Utilization Management Appeal Form. You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. Print and mail the form to your local Blue Cross and Blue Shield company by December 31 of the year following the year you received service. All rights reserved. Three forms are also available to aid providers in preparing an appeal request. Available plans and pricing may vary depending on whether you purchase your plan on or off the Health Insurance Marketplace. Preservice and concurrent appeals should continue to be submitted to the member's Home Plan. 2023 New Directions Behavioral Health. If you have questions, please contact your local Blue Cross and Blue Shield company. We use cookies on this website to give you the best experience and measure website usage. $('#chat-available').hide(); For standard policies - all Qualified LTC expenses will be paid in full until you reach your Maximum Monthly Benefit (31 x your Daily Benefit Amount). Blue Cross and Blue Shield of Alabama. Handbook, Incorporation 450 Riverchase Parkway East Lexington, KY 40512. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. We will give you a response within 72 hours of receiving all information we need to make a decision for a standard review. Or mail a paper copy, along with proof that you paid a Medicare Part B premium, to: Complete the form following the instructions on the back. Tell us the type of service or supply for which you wish to file a claim (for example, hospital, physician, dentist or pharmacy), and we will send you the proper type of form. Check out the changes and updates to our plan in 2023. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. We make completing any Dental Claim Form - Blue Cross And Blue Shield Of Alabama - Bcbsal easier. Claim entry screens are divided into five categories: Patient, Claim Information, LineInformation, Other Insurance and Adjustments. Choose a state to see how Blue Cross Blue Shield is working in your community. Theft, Personal To continue to the HealthEquity website, click "Accept." An EOB is a statement that describes what medical treatments and/or services we paid on your behalf, what our payment was and your financial responsibility under the terms of the plan. Not a provider, but want to search our network?Search for Providers. The 34 independent BCBS companies insure more than 107 million members across all 50 states, the District of Columbia, and Puerto Rico 107 M members covered $ 382 M+ invested in community health initiatives 572 K+ Employee volunteer hours Blue Cross and Blue Shield of Alabama You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. Box 3836, Scranton, PA 18505; Blue Cross Medicare Advantage, c/o Provider Services, P.O. Payer Name: Blue Cross Blue Shield of Alabama Payer ID: 510 Enrollment Required (ENR): Yes Type / Model: Commercial/Par State: AL Professional (CMS1500)/Institutional (UB04) [Hospitals] Real Time Eligibility (RTE): NO Real Time Claim Status (RTS): NO Electronic Remittance Advice (835) [ERA]: YES Secondary Electronic Claims (SEC): YES Claim submission is supported for primary, secondary and tertiarypayment. *Subject to your Calendar Year Deductible. Blue Cross and Blue Shield of Alabama enrolls and credentials all individual providers as well as ancillary and facility providers. If you use our Care Coordinator services in developing your Plan of Care, and your claim is initiated with Home or Community Services, then your Lifetime Waiting Period will be reduced by half. Business. Dental Blue Benefit Summary Plan Benefit In-Network Benefits Dental Blue 2500A Dental Blue 2000A Dental Blue 1500A Dental Blue 1500B Dental Blue 1000A Dental Blue 1000B MAJOR SERVICES (CONTINUED) Major Services - Prosthetic Services to deductibleInlays, onlays, veneers or crowns Fixed or removable bridges Full or . Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. If your ID card is not available, you may use one of the Customer Service telephone numbers below. . If services were rendered in New York or Pennsylvania, then use the state-specific file address PDF. var jsonStr = jQuery.parseJSON(data); Please review the terms of use and privacy policies of the new site you will be visiting. Call Customer Service at 1-855-504-BLUE (2583), 8 a.m. - 8 p.m. EST Monday - Friday, or Contact Us for further assistance. Member Services For general inquiries, you can reach us by calling the number below. Shop On Exchange Shop Off Exchange HOW TO BUY AN AFFORDABLE CARE ACT (ACA) PLAN What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Highest customer reviews on one of the most highly-trusted product review platforms. It includes the date you received the service, the amount billed, the amount covered, the amount we paid and any balance you're responsible for paying the provider. Liferay.on( allows healthcare providers to submit claims electronically to Blue Crossand Blue Shield of Alabama. Email the Sales Call Center (AdviseMe@bcbsal.org) anytime. Call 1-855-488-2515. I want to purchase services for my organization. Your doctor or other prescriber must give us a statement that explains the medical reasons for requesting an exception. Blue Cross Blue Shield of Alabama. An application, from the Enrollment section, is needed for any provider in the following situations: In certain situations, a claim may be reprocessed and denied retroactively, even after it has been paid. Access a wealth of healthcare resources and tools with MyBlue. Service, Contact This login is for your Employer Account. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Information contained in the external sites is not endorsed by BCBSAL. Additional details about this and other exception review details can be found in the Claims and Appeals section of your benefit booklet. For more information about the appeals process, see the following: Providers are required to file all post-service appeals to their local Blue Cross Plan regardless of the member's Home Plan. All rights reserved. Birmingham, Alabama 35244-2858, Grace periods and claims pending policies during the grace period. Drug exceptions timeframes and enrollee responsibilities. Outside the United States. Spanish, Localized Node:bclrprvappp1002.corp.bcbsal.org:8080 . To continue to this website, click "Accept." Medical necessity and prior authorization timeframes and enrollee responsibilities. Box 14053 We reference sites that we think might be useful or of interest to you, but we are not responsible for the content or privacy practices used by other site owners. CLAIM.MD | Payer Information | AL BCBS Payer Information AL BCBS Payer ID: 00510 This insurance is also known as: Blue Cross Blue Shield of Alabama Other ID's: SB510, 12B54 Need to submit transactions to this insurance carrier? All rights reserved. Choose between our 3 dental plans today! The Blue Cross representative will assist you in developing a Plan of Care - a guide in determining the type and frequency of care services you need. Fax (provider credentialing applications and related documents): 205-220-9545. Print and complete the form according to instructions on the front. Already a Blue Cross member and have questions about your current plan? Complete the form following the instructions on the back. For Indemnity policies - you will be paid your applicable Daily Benefit Amount. The following documentation provides guidance regarding the process for appeals. What is the fax number for BCBS of Alabama Dental Claims? For example, if an Alabama physician provides services to a member with Blue Cross and Blue Shield of Kansas coverage and a post-service appeal is needed, the physician should fill out the appropriate form from above and submit it to Blue Cross and Blue Shield of Alabama. There is a grace period of three months for all monthly premium payments after the initial premium payment. Here are the forms/documents to add locations and make changes to information and other requests. Out-of-network liability and balance billing. FSAFEDS (Reimbursement Options) Form Visit Page. Listed below are claims payment policies and other information for Qualified Health Plans offered by Blue Cross and Blue Shield of Alabama. /* Us, Delete If we deny your request, you may request an internal appeal and an external review by an impartial third party reviewer, known as an Independent Review Organization (IRO). function() { Access the most extensive library of templates available.
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