Telephone Directory FAX NUMBER. BlueCare Service Representatives (Customer Service) - for Providers

Transcription

1 Telephone Directory BlueCare Service Representatives (Customer Service) - for Providers BlueCare HMO BlueCare Traditional (Blue Cross & Blue Shield) BlueCare PPO BlueCare EPO myblue Choice/Access/Care/Cross Please note: Phone number includes all products under that heading BlueCare Service Representatives (Customer Service) - for Members BlueCare HMO BlueCare Traditional (Blue Cross & Blue Shield) BlueCare PPO BlueCare EPO myblue Choice/Access/Care/Cross Please note: Phone number includes all products under that heading Provider Relations Department or Health Management Programs (for Disease, Care and Lifestyle Management) Managed Pharmacy Program / Fax # (570) Medical Directors NaviMedix Customer Service (for system issues) First Priority Health Outpatient Non-Participating Authorizations & Fax # (570) and Fax # for Pediatric (570) First Priority Health Precertification Blue Cross of NEPA Precertification (FPLIC Traditional and FEP) FPLIC PPO Precertification (includes all PPO products) FPLIC EPO Precertification (includes all EPO products) PerformCare FPH Blue Cross/FEP/FPLIC FAX NUMBERS DEPARTMENT BlueCare Traditional Department BlueCare PPO Department BlueCard ITS Department FPH Department FAX NUMBER (570) (For adjustments, reconsiderations, claims research requests) Other Party Liability (OPL)

2 Blue Cross Precertification Department (570) First Priority Health Precertification Department (570) First Priority Health Outpatient Non-Par Authorization Requests (570) (570) (Pediatric) Provider Relations Department (570) Credentialing Department (570) BlueCare Service Representative (Customer Service) (570) First Priority Health Complaint/Grievance Department (570) BCNEPA/FPH Pharmacy Department (570) Behavioral Health (PerformCare) FPH & FPLIC PROVIDER RELATIONS PHONE NUMBERS AND ADDRESSES Name Title Address Ashby, Odette (570) Elmy, Karen (570) Hashagen, Cheryl (570) Jenkins, Jill (570) Klimchak, Karen (570) Levenoskie, David (570) Lewis, MaryJo (570) LoPresto, Louise (570) Quaglia, Kevin (570) Wyandt, Tracie (570) Provider Relations Consultant Health System Analyst Health System Consultant Provider Relations Consultant Provider Relations Project Specialist Provider Relations Senior Manager Health System Analyst Health System Consultant Provider Services Senior Manager Provider Relations Consultant PRODUCT INFORMATION First Priority Health Product Prefix Paper Claim Address Telephone # BlueCare HMO (Base); YZH First Priority Health BlueCare HMO PLUS (POS); PO Box CHIP Kansas City, MO

3 Blue Cross of Northeastern Pennsylvania Product Prefix Claim Address Telephone # BlueCare Senior (group); YZM (institutional) Institutional BlueCare Security (non- group) ZAS (professional) Professional First Priority Life Insurance Company (FPLIC) Product Prefix Claim Address Telephone # BlueCare PPO and BlueCare PPO Qualified High Deductible (QHD) QFG BlueCare PPO Customized EBU, NNU, NTJ, NTQ, WOH, Groups GSQ, LPO, LYB, SRI, WMH BlueCare Direct; BlueCare Direct Advantage; BlueCare Direct Select; BlueCare Direct Essentials QFD BlueCare Direct Simplicity QEB BlueCare PPO (PPO plan QFR purchased on the Shop myblue Choice; myblue QFL Choice LP (QHDHP) (on myblue Choice; myblue Choice LP (QHDHP) (off QFF My Blue Cross, a Multi-State QFJ Plan (on

4 BlueCare Custom PPO QFI (formerly BlueCare EPO) (member works or resides in- area) BlueCare EPO (member QFO works or resides out-of-area) BlueCare QHD Custom PPO QFI (formerly BlueCare QHD EPO) AffordaBlue sm (EPO 3-Tier) QFZ (off exchange) AffordaBlue (on QFE myblue Access; myblue Access LP (QHDHP); myblue Access Catastrophic (on QFN myblue Access; myblue Access LP (QHDHP); myblue Access Catastrophic (off QFH myblue Care (on QFA myblue Care (off QFB Custom PPO (Purchased on QFQ the Shop BlueCare Traditional QFT NaviNet NaviNet Customer Care NaviNet Customer Care is available Monday Friday, 8:00 a.m. to 11:00 p.m., Saturday 8:00 a.m. 3:00 pm

5 Product Prefix Claim Address Telephone # ClassicBlue PPOBlue EPOBlue Various PO Box Camp Hill, PA DirectBlue ShortTermBlue SpecialCare PPOPlus MedigapBlue Various PO Box Signature 65 Camp Hill, PA FreedomBlue PPO FER, FEM, HQM, TDM (FER & FEM ending 12/31/2014) Par Providers: Medical & Surgical (UB 04 &1500): /Benefits/Eligibility Member Services: Effective 1/1/2015: HRT, USK, HRF FreedomBlue Non-Par Providers (1500): FreedomBlue Non-Par Providers (UB 04): FreedomBlue BlueCard NUCC 1500 providers send BlueCard : claims to Highmark BS & contact the phone # on the side for claims questions. Benefits & Eligibility: Blue (2583) NUBC 1450 providers send claims to your local Blue Cross & BlueCard contact your local Blue Cross for claims questions. Federal Employee FEP Program (FEP) (Blue Shield # for claims and eligibility) *This is for providers who bill on a CMS 1500 form. Blue Cross of NEPA FEP Federal Employee

6 Program (FEP) (Institutional ) *This is for providers who bill on a NUBC 1450 form (Blue Cross # for claims and eligibility) FreedomBlue Authorizations - Miscellaneous Highmark Blue Shield Predeterminations Pre-Authorization PO Box Camp Hill, PA Physician Precertification Inquires Precerts for providers who are calling for a member to be seen at a facility in the BCNEPA service area Highmark EDI Department Electronic claims billing Payor ID # Highmark Fee Schedule To obtain a copy of PremierBlue Shield allowances for the most frequently reported codes for your specialty, or a copy of your UCR profile, send in a letter of request to the address listed on the side. Fee Based pricing and Analysis PO Box Camp Hill, PA Include your full name, address and provider number, and indicate whether you are requesting your UCR profile, PremierBlue Shield allowances, or both. Behavioral Health Authorizations Radiology Management Program - Authorizations FreedomBlue PPO Other plans Outpatient, non-emergency advanced imaging for selected CT scans, selected MRI and MRA scans and PET scans. If NaviNet-enabled, use the authorization function on NaviNet. If not NaviNet enabled, call National Imaging Associates, Inc Option Option 4