Qmf Bcbs Prefix (2024)

FAQs

What is the prefix for Highmark Freedom Blue PPO? ›

The alpha prefix for Highmark FreedomBlue members is HKS or FEM for enrollment source Plan Code 363 and HKR or FER for enrollment source Plan Code 378.

Federal Employee Program

ID cards for FEP members do not display a three-character prefix. Rather, all FEP member ID numbers begin with the letter “R,” as highlighted on the sample ID card below.

The alpha prefix will identify the patient's BCBS Plan (for example: ZGP for Texas), the National Account to which the member belongs (for example: HBT for Halliburton) or the patient's international BCBS Plan (for example: ZZC for Italy).

PPOBlue provides higher-level reimbursem*nt for services received from network providers and lower-level reimbursem*nt for services received outside the network. The specific percentages for network and out-of- network services are determined by the particular employer group contract.

Freedom Blue PPO is a Medicare Advantage Preferred-Provider Organization that gives you coverage for every need - health, prescription drugs, routine dental, vision, hearing and preventive care.

The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing.  When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the member's card.

FEP Blue Cross and Blue Shield (BCBS) is the federal PPO (Preferred Provider Organization) plan.

It is a health insurer in Pennsylvania, and through a purchase in 1996, an insurer in West Virginia and also later Delaware. As Highmark Blue Cross Blue Shield, it is primarily available in 29 counties of western Pennsylvania.

What is the prefix starting with R for BCBS? ›

Member identification numbers beginning with “R” belong to Federal Employee Program (FEP) and will not have a three-character prefix when filing.

Glossary – Insurance and Medical Terminology – Common Terms. bcbs.com. Blue Cross Blue Shield.

But as of the beginning of the year every claim is getting a clearinghouse denial (2010BA) for invalid alpha prefix- but what's strange is BCBS FEP uses the prefix R and not any three-letter prefixes that would be getting denied. (I have verified all of these plans as active with the correct subscriber IDs. )

With Blue Cross and Blue Shield of Texas, you don't have to sacrifice comprehensive benefits or freedom-of-choice for affordability. Their Medicare Supplement plans provide substantial benefits at rates that can save you money over other plans.

If you use a practice management/hospital information system or billing service, and/or a clearinghouse other than Availity® or Passport/Experian for electronic claims submission, contact your vendor to confirm they are using the new Payer ID 66006.

Providers enrolled for EFT can expect to receive a separate transaction for all Freedom Blue claims associated with NAIC code 15460.

The three-character prefix identifies the Blue Cross and Blue Shield Plan to which the member belongs. Some member's ID cards may not have an alpha prefix. Please look for claim filing instructions on the back of the ID card. Please DO NOT randomly select a three-character prefix.

Is there any routine dental coverage provided with the Freedom Blue PPO plan? There is no routine dental coverage provided by the plan. Medicare covers accidental dental services only.

Timely Filing

within a certain time period after the last date of service relating to such claim or the payment/denial of the primary payor, or it will be denied by Highmark. Per the timely filing policy, any claim not received within 365 days of the last date of service will be denied for untimeliness.