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Claims Adjustments and Appeals

We’ll let you in on a secret…one of the biggest reasons for claim delays within BlueCard® is incorrect or missing alpha prefixes and identification numbers on claims. To help avoid future delays, follow four simple steps:  
Copy - First make copies of the front and back of the member’s ID card and pass this key information on to your billing staff. Be sure that the member has the most current ID card. Quick Tip: When you’re referring a patient or a patient’s information to a provider where there is not a face-to-face encounter, please include copies of the patient’s ID card and the patient’s complete identification number, which includes the alpha prefix.
Look - Find the three-character alpha prefix. For BlueCard, the alpha prefix identifies the member’s Blue Plan or national account. It is also critical for confirming membership and coverage. Quick Tip: Do not assume that the member’s ID number is the Social Security number. Use of the Social Security number on ID cards was generally phased out by January 1, 2006. Alpha prefixes change, so recheck the ID card occasionally.
Contact - Once you’ve identified the alpha prefix, call BlueCard Eligibility at 1.800.676.BLUE (2583) to verify the member’s eligibility and coverage or submit a claim status inquiry using ProviderAccess at Quick Tip: for faster processing, use electronic capabilities.
Submit - After you include all the necessary information; submit the claim to BCBSGa at P.O. Box 9907 Columbus, GA 31908. Also, make sure you price the claim according to your provider contract with BCBSGa. Quick Tip: For faster processing please submit your claims electronically to your BCBSGa which is your local Blue Plan.
Appeals for all claims are handled through BCBSGa. We will coordinate the appeal process with the member’s Blue Plan, if needed. 
If you have any further questions, call BCBSGa at 1-800-628-3988.  
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.