Use this form to submit a claim to be reimbursed for paying Medicare Part B premiums. url: "/ChatAvailabilityService/getAvailability?queueName=CID" An EOB is not a bill. 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. 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. A healthy smile is an important part of your family's overall health. It is your responsibility to ensure that you or your provider obtains precertification. From October 1 through February 14, we are available 7 days a week. 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. Thank you for your interest in our Short Term Plan. *Please do not contact LifePlans unless you have already contacted Blue Cross and Blue Shield of Alabama to start your claim. Service, Contact With US Legal Forms the entire process of completing official documents is anxiety-free. 2023, Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. Features expanded pediatric benefits for children up to the end of the month in which the member turns 19. Mail original claims to the appropriate address as noted below. 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 . Provider Appeals Blue Cross and Blue Shield of Alabama has an established appeals process for providers and physicians. Health . Please attach any additional information and/or medical records at the time of filing the appeal for consideration. 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. My Account, Forms in The following documentation provides guidance regarding the process for appeals. method: "GET", Download your FREE dental guide to learn more about 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. Your Lifetime Waiting Period begins after you have been deemed Chronically Ill (or to have a significant Cognitive Impairment) and you have incurred one Qualified Long-Term Care expense. I want to purchase services for my organization. A retroactive denial is the reversal of a previously paid claim. services, For Small 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. Spanish, Localized /* 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. Blue Cross Blue Shield of Oregon -Regence FEP Claims TLW13 USA Blue Cross Blue Shield of Rhode Island: CB870 W: USA Download the Medicare Reimbursement Account (MRA) Pay Me Back claim form: Complete the form following the instructions on the front. To continue to this website, click "Accept." If you want to stay on Blue Cross' website, click "Cancel.". #1 Internet-trusted security seal. 2023 New Directions Behavioral Health. } Include the date to the document using the Date function. The plan will only pay for care that is medically necessary and not investigational, as determined by us. 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. Include itemized bills for covered services or supplies. Generally, if precertification is required and not obtained, no benefits will be payable under the plan. To continue to the HealthEquity website, click "Accept." Forms, Real Estate **Dental Blue Plus is a Health Insurance Marketplace plan. 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. 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. By clicking "Next", you are acknowledging that you would like to submit your application and continue onto the payment page otherwise, click "Cancel". 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. Enjoy smart fillable fields and interactivity. CPT codes, descriptions and data copyright 2022 American Medical Association. 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. ); (You can fill the form in electronically or complete it by hand.). 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. Use this form to submit a claim to be reimbursed for services that are covered under Service Benefit Plan dental benefits. Equal Opportunity Employer AA M/F/Vet/Disability, We are excited to announce that New Directions and Tridiuum have joined forces to become Lucet! By clicking "Next", you are acknowledging that you would like to submit your application otherwise, click "Cancel". Provider. Birmingham, Alabama 35244-2858, Grace periods and claims pending policies during the grace period. There is a grace period of three months for all monthly premium payments after the initial premium payment. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. The case number, contract number and/or accident date you've entered does not match our records. (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). HealthEquity is our business associate and is an independent company that provides account-based plan services to Blue Cross. . Providing us with your name and email address allows us to contactyou. An employee or dependent who loses coverage under Medicaid or a State Children's. You may access the Nondiscrimination and Accessibility notice, Navigate & Connect: Simplifying access to behavioral healthcare. Find your plan. A Blue Cross representative from LifePlans will contact you to discuss your initial needs and to clarify any questions you have about your policy. Overseas members must file claim forms for any covered medical or pharmacy servicesreceived outside of the United States. 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. FSAFEDS (Reimbursement Options) Form Visit Page. You may also visit them online at BCBSAL. 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. 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 Patient Eligibility and Benefits; Pre-Service Review; Pre-Service Review for Out-of-Area Members . Handbook, Incorporation Listed below are claims payment policies and other information for Qualified Health Plans offered by Blue Cross and Blue Shield of Alabama. Liferay.on( Some information on our siteis secure; log in to ensure youre seeingall the news. Member Services For general inquiries, you can reach us by calling the number below. Using an electronic vendor approved with Blue Cross and Blue Shield of Alabama, submit an electronic claim using a valid Tax ID, Individual NPI and Organizational NPI. Adults age 19+. BCBS FEP Dental Claim Form View PDF. Your doctor or other prescriber must give us a statement that explains the medical reasons for requesting an exception. Planning, Wills 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. 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. 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). Are you a provider?Click to be directed to our Providers area. If you want to stay on Blue Cross' website, click "Cancel.". 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. 3. function checkChatAvailability(userAction) { All rights reserved. By continuing to use this website, you consent to these cookies. Box 302150 Montgomery, AL 36130 or 135 South Union Street Montgomery, AL www.rsa.state.al.us Customer Service Node:bclrprvappp1001.corp.bcbsal.org:8080 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. Box 14053 Reimbursement will be sent to claimant; no claims are paid directly to provider. Download the overseas medical claim form: If you want to stay on the Blue Cross website, click "Cancel.". Highest customer reviews on one of the most highly-trusted product review platforms. Dental Expense Claim Author: Blue Cross and Blue Shield of Alabama Subject: Dental Expense Claim Keywords: Dental Expense Claim,dental expense,dental,expense,claim Created Date: Blue Cross and Blue Shield of Alabama. Call the IVR: 205-220-6765. This link takes you to another website. $('#chat-available').hide(); gives you access to exams, X-rays and routine cleaningsat no 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. CPT codes, descriptions and data copyright 2022 American Medical Association. Blue Cross Blue Shield of Alabama CBAL1: W USA: Blue Cross Blue Shield of Alaska 47570: USA . } Node:bclrprvappp1002.corp.bcbsal.org:8080, Pre-Service Review for Out-of-Area Members, Anesthesia Sedation for Dental or Oral Surgery Procedures, Notification of Noncovered Dental Services, Predetermination of Benefits for Veneers and Anterior Crowns. Heres everything you need to know about it. //show the chat un-available image Thank you for your interest in our Short Term Plan. contact your local Blue Cross and Blue Shield company. allows healthcare providers to submit claims electronically to Blue Crossand Blue Shield of Alabama. 13. 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. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. Theft, Personal TopTenReviews wrote "there is such an extensive range of documents covering so many topics that it is unlikely you would need to look anywhere else". Patient & Claim. If you have questions, please contact your local Blue Cross and Blue Shield company. In that case, you will be responsible for all charges billed to you by the out-of-network provider. These guidelines, in addition to the editor will assist you through the entire procedure. Medical necessity and prior authorization timeframes and enrollee responsibilities. 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. 2023, Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. Shop On Exchange Shop Off Exchange HOW TO BUY AN AFFORDABLE CARE ACT (ACA) PLAN In certain situations, a claim may be reprocessed and denied retroactively, even after it has been paid. To continue to this website, click "Accept." Provider Phone Numbers PEEHIP P.O. Family. Box 3836, Scranton, PA 18505; Blue Cross Medicare Advantage, c/o Provider Services, P.O. A powerhouse editor is already at your fingertips supplying you with a range of useful instruments for filling out a Dental Claim Form - Blue Cross And Blue Shield Of Alabama - Bcbsal. else $.ajax({ 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. If your ID card is not available, you may use one of the Customer Service telephone numbers below. View the latest providernews. Additional details about this and other exception review details can be found in the Claims and Appeals section of your benefit booklet. We will give you a response within 72 hours of receiving all information we need to make a decision for a standard review. (You can fill the form in electronically or complete it by hand.). */ The following documentation provides guidance regarding the process for appeals. What is the fax number for BCBS of Alabama Dental Claims? If you want to stay on the Blue Cross website, click "Cancel.". COB provisions determine which plan is primary and which is secondary. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. An EOB is an outline of what services you received from a provider and how your benefits were applied to cover those services. Technology, Power of If you use a provider outside of our network, you'll need to complete and file a claim form to be reimbursed. Available plans and pricing may vary depending on whether you purchase your plan on or off the Health Insurance Marketplace. This login is for your Employer Account. Three forms are also available to aid providers in preparing an appeal request. window.open('https://cicqaaux.corp.bcbsal.org/I3Root/chatpopup.html?qname=cid_chat&fromUrl='+fromUrl, '', 'width=700, height=600'); Get your online template and fill it in using progressive features. 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. 2023, Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. Questions? You can file your expenses for reimbursement as frequently as you want. Attorney, Terms of Information on Explanations of Benefits (EOBs). What is the timely filing limit for BCBS of Alabama corrected claims? Call 1-855-890-7416, 8 a.m. - 8 p.m. Central Time, Monday through Friday. It also tells you how much has been credited toward any required deductible and out-of-pocket maximums. When we receive an electronic claim, you will automatically be set up as an out-of-state provider in our systemand can register to use our provider website,ProviderAccess: Once you have registered for ProviderAccess, you can also use on our online claim entry application,eClaims, to submit claims to us: Resources for Out-of-State Dental Providers: CPT codes, descriptions and data copyright 2022 American Medical Association. Information contained in the external sites is not endorsed by BCBSAL. Choose a state to see how Blue Cross Blue Shield is working in your community. I have reviewed the following treatment plan. Register Now. 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). Blue Cross Blue Shield of Alabama. Submit a separate claim for each patient. Blue Cross and Blue Shield of Alabama has an established appeals process for providers and physicians. 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. Node:bclrprvappp1001.corp.bcbsal.org:8080, Pre-Service Review for Out-of-Area Members. Get Started Please review your information to continue. Complete the form following the instructions on the back. Preservice and concurrent appeals should continue to be submitted to the member's Home Plan. Learn more >, New Directions complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. In the left-hand column, locate the state where services were rendered. If you do not know this information, please contact us at 205-220-7725 or fax your request to 205-220-6354. Follow the simple instructions below: The days of distressing complex legal and tax forms have ended. A secondary plan is one which takes into consideration the benefits of the primary plan before determining benefits available under its plan. You should be sure to check with your provider to confirm whether precertification has been obtained. Patient Consent Form for Provider Submitted Appeals View PDF. English Espaol. Choose between our 3 dental plans today! 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. **Dental Blue Plus is a Health Insurance Marketplace plan. Call Preferred Long-Term Care (LTC) Customer Service (1-888-331-4188) to complete the Claims Intake Form over the telephone. Guarantees that a business meets BBB accreditation standards in the US and Canada. Double-check every area has been filled in correctly. Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. We use cookies on this website to give you the best experience and measure website usage. We must follow the IROs decision. Submit a separate claim for each patient. Use this form to submit a health benefit claim for services that are covered under the Blue Cross and Blue Shield Service Benefit Plan. Dental. Some information on our site is secure; log in to ensure you're seeing all the news. Call Customer Service at 1-855-504-BLUE (2583), 8 a.m. - 8 p.m. EST Monday - Friday, or Contact Us for further assistance. Applicable FARS/DFARS apply. 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. Print and mail the form to the Blue Cross and Blue Shield company in the state that the services were rendered by December 31 of the year following the year you received service. Forms 10/10, Features Set 10/10, Ease of Use 10/10, Customer Service 10/10. Please review the terms of use and privacy policies of the new site you will be visiting. To determine your premium, call us at 1-855-488-2515 or click the "Get Started" link to compare your plans today. . For questions about claims payments, health, and dental benefits, or to order insurance cards, please call Blue Cross and Blue Shield of Alabama at 1-800-760-6851. CPT codes, descriptions and data copyright 2022 American Medical Association. 1.833.663.8713 Other ways to connect By mail Credence Blue Cross and Blue Shield 450 Riverchase Parkway East Birmingham, Alabama 35244 Physicians and providers Credence Blue Cross and Blue Shield 450 Riverchase Parkway East Birmingham, Alabama 35244 In some cases, your provider will initiate the precertification process for you. 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. You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. All rights reserved. Provider Enrollment $129 /month. Blue Plus **. 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. When you receive services from an in-network provider, your provider will generally file claims for you. 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. 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. }).then(function(data) { All Rights Reserved. Choose between our 3 dental plans today! Claim forms must be submitted to: By clicking "Next", you are acknowledging that you would like to submit your application otherwise, click "Cancel". }); All rights reserved. Email the Sales Call Center (AdviseMe@bcbsal.org) anytime. You can purchase ACA healthcare plans through a federal marketplace called the Health Insurance Marketplace or outside the Health Insurance Marketplace. 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. In some cases, the plan requires that you or your treating provider precertify the medical necessity of your care. Don't have a User ID? If you fail to pay in full all periodic monthly payments due and payable before the end of the grace period for those coverage periods, your coverage under the plan will be retroactively canceled back to the last day of the first month of the grace period. 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. 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 at 1-855-488-2515 or click the "Get Started" link to compare your plans today. HealthEquity has agreed to follow Blue Cross' privacy and security policies regarding the confidentiality and protection of your personal health information. 2023 Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue ShieldAssociation. Claim submission is supported for primary, secondary and tertiarypayment. 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. Some areas of our site may provide links to other external sites that we don't own, control or influence. 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. Instructions: 1. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Attach pharmacy receipts for covered prescriptions. ALL Kids. Questions? Thank you for your interest in our Short Term Plan. (SLC mailing address ) 61473: USA Blue Cross Blue Shield of North Carolina (Winston Salem mailing addr 61473 . For claim status, eligibility, remittances and referrals, use one of the following methods: Access through your practice management software, Log in to our website, or Call the appropriate number listed below: In-State General Provider Inquiry Participating hospitals: 1-800-760-6852 Participating providers: 1-877-231-7239 HealthEquity has agreed to follow Blue Cross' privacy and security policies regarding the confidentiality and protection of your personal health information. Blue Cross and Blue Shield of Alabama * Sign up today and get a plan that's accepted by over 1,700 { Our representatives can answer your questions and help you navigate these choices. 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. function() { Blue Cross Community Health Plans, c/o Provider Services, P.O. myBlueCross Member Login Contact Us: 1-888-543-9212 (TTY:711) myBlueCross Member Login Call 1-888-543-9212 TTY 711 . Blue Cross and Blue Shield of Alabama enrolls and credentials all individual providers as well as ancillary and facility providers. CDT codes, descriptions and data copyright 2022 American Dental Association. Someone will get back to you within two business days. 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. Fax (provider credentialing applications and related documents): 205-220-9545. Include proof that you paid a Medicare Part B premium. $('#chat-available').show(); Features expanded pediatric benefits for children up to the end of the month in which the member turns 19. Claims Administrator Get access to thousands of forms. 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? window.open('https://cicchat.bcbsal.org/I3Root/chatpopup.html?qname=cid_chat&fromUrl='+fromUrl, '', 'width=700, height=600'); I authorize release of any information relating to this claim. You can use our interactive search to find your local Blue Cross Blue Shield Company's website. Call 1-855-488-2515. Find out More (For example, if your service was provided on March 5, 2022, you have until December 31, 2023 to submit your claim). $23 /month. Home - provider.bcbsal.org Patient & Claim Payment & Refund Visit our COVID-19 Provider Update Center for the latest information about testing, treatment and telehealth coverage. Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us. What is the dental number for Blue Cross Blue Shield of Alabama? Experience a faster way to fill out and sign forms on the web. Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us. To continue to the HealthEquity website, click "Accept." All rights reserved. If you purchased an individual plan through the health insurance marketplace and you are receiving advance payments of tax credits and/or cost sharing reductions in accordance with the Affordable Care Act, each of your monthly periodic payments is due on the first day of the month for that coverage period. Box 3418, Scranton, PA 18505; Blue Cross Community MMAI (Medicare-Medicaid Plan), c/o Provider Services, P.O. What is the fax number for BCBS Alabama appeals? You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. Name and Address of Carrier . Claim entry screens are divided into five categories: Patient, Claim Information, LineInformation, Other Insurance and Adjustments. 2. 450 Riverchase Parkway East Upon completion of your Waiting Period, you will be eligible to begin receiving reimbursement of your benefits. the page. 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. If you are a contracted health plan partner, then you have a dedicated account manager you can call upon at any time for any reason. If you or your doctor believe there are exigent circumstances that require an expedited review, an expedited exception request can be submitted, and we will give a response within 24 hours. Enroll as a Blue Cross provider, update provider information, or begin the credentialing/recredentialing process. USLegal received the following as compared to 9 other form sites. 'allPortletsReady', Business. Access the most extensive library of templates available. Find your smile. Print and complete the form according to instructions on the front.
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