Insurance ID format - major insurance of Florida

Insurance ID format - major insurance of Florida

 Here is the list of some major insurance and insurance id format

Insurance name	ID# Format	Comments
AARP Health care	961574644	9 Digit Number and this Insurance always be a secondary because this medicare supplement plan
AARP Medicare Complete	915336628	9 Digit Number and this Insurance always be a Primary because this Medicare HMO plan
Advantra Coventry	809118617	9 Digit Number
Advantra Freedom Medicare	809323417	9 Digit Number and this Insurance always be a Primary because this Medicare HMO plan
Aetna	W101444750	Commercial
	BBJV4HQA	Aetna HMO
	578822521	Commercial
American Pioneer	031102740	9 Digit Number and this Insurance always be a secondary
Amerigroup	714891947	9 Digit Number
APWU	914135950	9 Digit Number
AVMED	A1027011906	Always ID# begin with A followed by 10 digits
Bankers Life Casualty	209074071	9 Digit Number
BCBS	POKH92835893 XJMH91442935	Florida BCBS always has Letter "H" after three Alpha character
	R51006221	ID# begin with "R" followed by 8 digit
	YLS890449801 YJX88001309101	Blue option plan
Champva	ID# is Patient SSN#	Champva is secondary to most other health plan and champva is primary to medicaid
Cigna	U33611831	Always ID# begin with "U" followed by 8 digits
Careplus	1206720	7 Digit Number and This is Medicare HMO Plan
Cigna - Baycare	100119500	9 Digit Number
Evercare	857716531	9 Digit Number and This is Medicare HMO Plan
Freedom Health	P0003496501	Always ID# begin with "P" followed by 10 digits
GEHA	21228436	8 Digit Number
GHI	930632448	9 Digit Number
Golden Rule	058827372	9 Digit Number
Hospice	ID# is Patient SSN#	Always primary and hospice does not insurance company
Humana	H46899857	Mostly ID# begin with "H" it might be Medicare HMO plan and Non-Medicare HMO plan
	700375124	9 Digit Number and this Non - Medicare HMO plan
MHBP (Mail HandlersBenefit plan	784080159-02	11 Digit Number
Medicaid	7915832042	10 Digit Number
Medicare	206344498A and 340018309C1	9 Digit followed by one alpha and ( Exception case 340018309C1)
NALC	N32233015	ID# begin with "N" followed by 8 digit
Optimum Health	T0001965601	Always ID# begin with "T" followed by 10 digits
QHP	MCR515769	Always ID# begin with "MCR" followed by 6 digits
Rail Road Medicare	A721031033	ID# begin with alpha beore numeric
Tricare	ID# is Patient SSN#	9 Digit Number
UHC	854728427	9 Digit Number
Universal Healthcare	MM557410087	ID begin with TWO alpha followed by 9 digit numbers

BCBS of TEXAS - Alpha Prefix Importance

Most members with coverage through a Blue Cross Blue Shield Plan are assigned a three letter alpha prefix as a part of their unique identification number. The alpha prefix can easily be identified as it is the first three characters.

The alpha prefix is very important to the identification number. The prefix acts as a key element in confirming the members’ eligibility and coverage information. Prefixes are also used to identify and correctly route claims to the appropriate Blue Cross Blue Shield Plan for processing.

There are two types of alpha prefixes: plan-specific and account-specific.

Plan-Specific alpha prefixes are assigned to each plan. The first two characters of the prefix identifies each plan and the third character identifies the type of product the member is enrolled in.

Example: Prefix "ZGP" (Blue Cross Blue Shield of Texas - PPO Product)

1st Character "Z" Plan Specific (letter assigned to the BCBS Plan)

2nd Character "G" Plan Specific (letter assigned to the BCBS Plan)

3rd Character "P" PPO Product (letter assigned by the BCBS Plan to identify product type elected by the member)

Account-Specific alpha prefixes are assigned to national accounts. National accounts are employer groups that have offices across multiple states but offer standardized coverage to their employees. Normally, the alpha prefix assigned to national accounts will associate to the employer group name.

Example: Prefix "UTS" (University of Texas - National Account)

Identification Cards without an Alpha prefix:

Some identification cards may not include an alpha prefix, which may indicate that the claim filing instructions for these type policies are different. We suggest that you verify claim filing instructions during the time eligibility information is obtained. If not, please follow the instructions on the back of the member's ID card or contact the plan directly. Member eligibility can be obtained at 1 (800) 676-BLUE (2583). Once connected, you will then simply provide the alpha prefix and the operator will then route you to the member's plan.

Helpful Tips Related to the Alpha Prefix:

    * Do not omit or randomly select an alpha prefix.

    * Do not substitute another Blue Cross Blue Shield Member’s prefix.

    * Include the alpha prefix and all alpha numeric characters preceding the alpha prefix on all correspondence and claims submitted to Blue Cross Blue Shield of Texas.

    * The alpha prefix is always three letters followed by the member's ID number which can be from 6 up to 14 characters total.

    * If possible, make copies of the member's ID card (front and back) for your records.

    * We recommend that you obtain a copy of the ID card any time there has been a coverage or policy change. If there are no changes, we suggest that you obtain card copies annually.

Medical billing insurance card terms and definition - ID format

INSURANCE CARDS ID FORMAT

Insured Name – Should always be set up EXACTLY as it appears on the card.  This is especially important since Medicare and Medicaid will deny if the name on the claim sent does not match the name on the card.

Group, Policy and ID#’s – Should be entered WITHOUT any dashes.  Example: policy# 475-70-5040 would be entered as 475705040.

Blue Cross/Shield – For Federal plans where ID begins with “R” and outstate plans that have an alpha prefix before the ID (example:  XZA475705040) claims are filed to your home plan.  For non-prefixed ID’s (example: 475705040) claims would go to the Blue Cross/Shield plan specified on the card.  It is very important that the employer and group are included in the registration.

PPO vs. NON-PPO – If you belong to the PPO, claims are submitted to them.  If not, the cards should indicate where to send the Non-PPO claims.  Examples:  Wynnewood Refining Company, PPO Claims go to PPO Oklahoma, Non-Network claims go to Gallagher Benefit Administrators.  Mid-South Iron Workers, PPO claims go to CompMed Physicians, Non-Network claims go to Zenith Administrators.

Worker’s Compensation Claims – Always try to obtain the worker’s compensation claims information and send the claims to them, rather than an employer.  There are a few unscrupulous employers who will have the bill sent to them and then have never filed the claim and fail to reimburse the facility.

Auto Insurance - Auto accident information should be entered even if the patient was not at fault or does not have auto insurance in case litigation is warranted.  Any information entered, even in notes, can be helpful.  Auto accidents can take many years to reach a settlement and documentation taken near the time of the accident can be critical to the site being reimbursed for treatment costs.

Tribal Self-Insurance – Even though it is not billable for Federal IHS sites, the information still needs to be entered and adjusted off for cost accounting purposes.  Contract Health Services needs this to coordinate benefits.

Dental, Pharmacy, Vision, and Mental Health Insurance – Often, if patient has dental, pharmacy, vision or mental health insurance coverage, a different company is administering the benefits, not the medical insurance carrier.  The ROI/AOB and MSP are conditions of participation (CoP) in the Mcare program.