Claim submission is supported for primary, secondary and tertiarypayment. Rev 3/2007 It also tells you how much has been credited toward any required deductible and out-of-pocket maximums. Providers - ndbh.com Out-of-network liability and balance billing. Highest customer reviews on one of the most highly-trusted product review platforms. Brush up on important dental plan details Download your FREE dental guide to learn more about the range of plans available to you. You should be sure to check with your provider to confirm whether precertification has been obtained. Print and complete the form according to instructions on the front. Or mail a paper copy, along with proof that you paid a Medicare Part B premium, to: Complete the form following the instructions on the back. window.open('https://cicchat.bcbsal.org/I3Root/chatpopup.html?qname=cid_chat&fromUrl='+fromUrl, '', 'width=700, height=600'); */ . Resources - provider.bcbsal.org Blue Cross Blue Shield of Alabama. /* You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by Prime Therapeutics, LLC. CDT codes, descriptions and data copyright 2022 American Dental Association. USLegal received the following as compared to 9 other form sites. } Here are the forms/documents to add locations and make changes to information and other requests. Authorization to Release Information Form View PDF. (SLC mailing address ) 61473: USA Blue Cross Blue Shield of North Carolina (Winston Salem mailing addr 61473 . In that case, you will be responsible for all charges billed to you by the out-of-network provider. var jsonStr = jQuery.parseJSON(data); Download your FREE dental guide to learn more about Get access to thousands of forms. ); If you receive out-of-network services for a medical emergency in the emergency room of a hospital, those services will be paid at the applicable in-network coinsurance amounts for benefits described in your benefit booklet, but subject to the out-of-network calendar year deductible.For emergency services for medical emergencies provided within the emergency room department of an out-of-network hospital, the allowed amount will be determined in accordance with the Affordable Care Act. Call Customer Service at 1-855-504-BLUE (2583), 8 a.m. - 8 p.m. EST Monday - Friday, or Contact Us for further assistance. Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. *Subject to your Calendar Year Deductible. Include the date to the document using the. Provider. 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. 2. 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. 2023, Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. Box 3418, Scranton, PA 18505; Blue Cross Community MMAI (Medicare-Medicaid Plan), c/o Provider Services, P.O. if (jsonStr.Availability === 'YES') { It is your responsibility to ensure that you or your provider obtains precertification. the range of plans available toyou. Claim Submission | Blue Cross and Blue Shield of Illinois - BCBSIL By clicking "Next", you are acknowledging that you would like to submit your application otherwise, click "Cancel". PDF State Mail to Mailing Address City, State Zip - Pnnl Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us. if (userAction === 'onclick') { Contact Us | Credence Blue Cross and Blue Shield Health Insurance Claims Payment Policy & Other Information - bcbsal.org How to file a dental claim with Blue Cross Blue Shield Alabama? 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. myBlueCross Member Login Contact Us: 1-888-543-9212 (TTY:711) myBlueCross Member Login Call 1-888-543-9212 TTY 711 . } else { If you want to stay on the Blue Cross website, click "Cancel.". dental, vision, hearing and fitness benefits at no added cost . 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. There is a grace period of three months for all monthly premium payments after the initial premium payment. Please review the terms of use and privacy policies of the new site you will be visiting. Double-check every area has been filled in correctly. the page. HealthEquity is our business associate and is an independent company that provides account-based plan services to Blue Cross. & Estates, Corporate - 3. extra cost. Claims Payment Policy & Other Information. 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: CDT codes, descriptions and data copyright 2022 American Dental Association. Resources - provider.bcbsal.org Additionally, out-of-network providers have not contracted with us or any Blue Cross and/or Blue Shield plan for negotiated discounts and can bill you for amounts in excess of the allowed amounts under the plan. 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 . contact your local Blue Cross and Blue Shield company. Contact Us | Alabama Department of Public Health (ADPH) How to Submit a Claim - Blue Cross and Blue Shield's Federal Employee When you receive services from an in-network provider, your provider will generally file claims for you. Blue Cross Blue Shield What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Some information on our siteis secure; log in to ensure youre seeingall the news. 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). 13. Blue Cross and Blue Shield of Alabama Submit a separate claim for each patient. Call 1-855-488-2515. Some information on our site is secure; log in to ensure you're seeing all the news. Listed below are claims payment policies and other information for Qualified Health Plans offered by Blue Cross and Blue Shield of Alabama. } at 1-855-488-2515 or click the "Get Started" link to compare your plans today. 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. Resources - provider.bcbsal.org The protection of your privacy will be governed by the privacy policy of that site. An application, from the Enrollment section, is needed for any provider in the following situations: Forms, Real Estate 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. Us, Delete You can file your expenses for reimbursement as frequently as you want. 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. } Questions? Service, Contact Birmingham, Alabama 35244-2858, Grace periods and claims pending policies during the grace period. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association. 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. Blue Cross and Blue Shield of Alabama will send you a Claims Packet to be completed and returned to us. Choose a state to see how Blue Cross Blue Shield is working in your community. Precertification also does not mean that we have been paid all monies necessary for coverage to be in force on the date that services or supplies are rendered. P.O. $.ajax({ 2023, BlueCross and BlueShield of Alabama is an independent licensee of the BlueCross and BlueShield Association. **Dental Blue Plus is a Health Insurance Marketplace plan. View the latest providernews. Blue Cross and Blue Shield of Alabama Preferred Long-Term Care Customer Service: 1-888-331-4188 or 1-205-733-7019, Blue Cross and Blue Shield of Alabama Preferred Long-Term Care Customer Accounts: 1-205-220-4503, LifePlans Claims Services:* 1-800-525-7279 extension 273, LifePlans Provider Pathway:* 1-800-886-7404 or. Use this form to submit a health benefit claim for services that are covered under the Blue Cross and Blue Shield Service Benefit Plan. Contact Us | Blue Cross Blue Shield Box 303017 Montgomery, AL 36130-3017. If services were rendered in New York or Pennsylvania, then use the state-specific file address PDF. Find your smile. Expenses will be applied against your Plan of Care and reimbursed accordingly. Features expanded pediatric benefits for children up to the end of the month in which the member turns 19. 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. Lexington, KY 40512. 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. $129 /month. All rights reserved. Don't have a User ID? If you have questions, please contact your local Blue Cross and Blue Shield company. In the left-hand column, locate the state where services were rendered. If you want to stay on Blue Cross' website, click "Cancel.". I want to purchase services for my organization. Blue Cross Community Health Plans, c/o Provider Services, P.O. BCBS FEP Dental Claim Form View PDF. $23 /month. Mail original claims to the appropriate address as noted below. BCBS Provider Phone Number list updated (2023) Get Started What is the fax number for BCBS Alabama appeals? Payer Name: Blue Cross Blue Shield of Alabama - thePracticeBridge }); An employee or dependent who loses coverage under Medicaid or a State Children's. Include the date to the document using the Date function. Health . Additional details about this and other exception review details can be found in the Claims and Appeals section of your benefit booklet. Patient. You can take the Blue Health Assessment, check drug costs, change your address, request a member ID card and more. Using this login enables you to manage the account for your organizations participating members. PDF Dental Expense Claim - bcbsal.org Attach pharmacy receipts for covered prescriptions. (You can fill the form in electronically or complete it by hand.). Available plans and pricing may vary depending on whether you purchase your plan on or off the Health Insurance Marketplace. Each time Blue Cross processes a claim submitted by you or your healthcare provider, we send you an Explanation of Benefits (EOB). BCBS State by State | Blue Cross Blue Shield Box 3836, Scranton, PA 18505; Blue Cross Medicare Advantage, c/o Provider Services, P.O. function() { A secondary plan is one which takes into consideration the benefits of the primary plan before determining benefits available under its plan. 450 Riverchase Parkway East 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. Follow the simple instructions below: The days of distressing complex legal and tax forms have ended. 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. 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. 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Dental Claim Form - Blue Cross And Blue Shield Of Alabama - Bcbsal 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. 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. Provider Appeals Blue Cross and Blue Shield of Alabama has an established appeals process for providers and physicians. If your ID card is not available, you may use one of the Customer Service telephone numbers below. Applicable FARS/DFARS apply. If you receive services from an out-of-network provider, these services may not be covered at all under the plan. Node:bclrprvappp1001.corp.bcbsal.org:8080, Pre-Service Review for Out-of-Area Members. We make completing any Dental Claim Form - Blue Cross And Blue Shield Of Alabama - Bcbsal easier. Dental. Three forms are also available to aid providers in preparing an appeal request. Shop On Exchange Shop Off Exchange HOW TO BUY AN AFFORDABLE CARE ACT (ACA) PLAN Generally, if precertification is required and not obtained, no benefits will be payable under the plan. Node:bclrprvappp1002.corp.bcbsal.org:8080 . Three forms are also available to aid providers in preparing an appeal request. Questions? Find your plan. Blue Cross Blue Shield FEP Dental - Forms For Indemnity policies - you will be paid your applicable Daily Benefit Amount. }. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Blue Cross Blue Shield FEP Dental - Contact Us 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. Dental Blue Benefit Summary Plan Benefit In-Network Benefits Dental Blue 2500A Dental Blue 2000A Dental Blue 1500A Dental Blue 1500B Dental Blue 1000A Dental Blue 1000B MAJOR SERVICES (CONTINUED) Major Services - Prosthetic Services to deductibleInlays, onlays, veneers or crowns Fixed or removable bridges Full or . Technology, Power of Phone Numbers. Download and complete the appropriate form below, then submit it by December 31 of the year following the year that you received service. Liferay.on( Use this form to submit a claim to be reimbursed for services that are covered under Service Benefit Plan dental benefits. From October 1 through February 14, we are available 7 days a week. $42 /month. 2023 Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue ShieldAssociation. 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. A Blue Cross representative from LifePlans will contact you to discuss your initial needs and to clarify any questions you have about your policy. Please attach any additional information and/or medical records at the time of filing the appeal for consideration. Submit a separate claim for each patient. By continuing to use this website, you consent to these cookies. Claim Statements Reimbursements Contract and Dependent Information Other Insurance Coverage Deductible & Out of Pocket Costs View Benefits and Coverage Resources Review and Pay my Bill ID Cards Forms and Materials Covered Immunizations Health Insurance Basics Policies and Guidelines Preventive Services Caregiver Resources Child up to age 19. else Download the overseas medical claim form: Include proof that you paid a Medicare Part B premium. How to File a Claim - Blue Cross and Blue Shield of Alabama Handbook, Incorporation You can purchase ACA healthcare plans through a federal marketplace called the Health Insurance Marketplace or outside the Health Insurance Marketplace. You are about to leave Blue Cross and Blue Shield of Alabama's website and enter a website operated by HealthEquity. Contact Us | Blue Cross and Blue Shield of Alabama - bcbsal.org The following documentation provides guidance regarding the process for appeals. 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. Blue Plus **. Ensures that a website is free of malware attacks.