docPrefix Listing This document provides the current prefixes
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Prefix Listing This document provides the current prefixes
Prefix Listing This document provides the current prefixes for Blue Cross and Blue Shield of Vermont, CBA Blue and New England Health Plan. It is updated periodically and posted to our provider website/references/prefix listing at www.bcbsvt.com. Notices about changes are posted to the news area of the provider website. Blue Cross and Blue Shield of Vermont (BCBSVT) Prefixes When you contract directly with BCBSVT regardless of what state service(s) are rendered in, all claims for these prefixes must be submitted to BCBSVT. Some exclusions apply for durable medical equipment, independent clinical laboratories and specialty pharmacy. Please refer to section 6 of the on-line provider manual for complete details. Care and Case Management, if/when applicable for these prefixes is done by BCBSVT. In some instances, we have partners that handle such as radiology by AIM Specialty Health or pharmacy by Express Scripts, Inc. (ESI). Customer Service inquiries are answered by BCBSVT staff. Prefix CWS DVT EVT FAC FAH FAO FVT OMY 01/27/15 Product and/or Account Casella Waste Systems (PPO) State of Vermont Health Guard (PPO) State of Vermont Select Care (EPO) University of Vermont Medical Center (formerly Fletcher Allen Health Care) Retiree (Indemnity) University of Vermont Medical Center (formerly Fletcher Allen Health Care) Preferred (VHP) University of Vermont Medical Center (formerly Fletcher Allen Health Care) Preferred (PPO) State of Vermont Total Choice (Indemnity) Omya (PPO) Reports to Remit under: Indemnity Indemnity Vermont Health Partnership (VHP) Indemnity Reimbursement Non Managed Non Managed Managed Non Managed Vermont Health Partnership (VHP) Managed Indemnity Non Managed Indemnity Indemnity R* ZIA ZIB ZID ZIE ZIF ZIG ZIH ZII ZIJ ZIK ZIL ZIU ZIV Federal Employee Program (PPO) BCBSVT – Indemnity BCBSVT – Vermont Blue 65/Vermont Medigap Blue BCBSVT Vermont Freedom Plan (PPO) BCBSVT - The Vermont Health Plan (TVHP) BCBSVT – VHP Open Access BCBSVT - Exchange Small Group (EPO) BCBSVT – Vermont Health Partnership (VHP) BCBSVT – Exchange Individual (EPO) BCBSVT – VHP HMO BCBSVT – EPO FEP Remit Indemnity Medicomp BCBSVT – EPO without Primary Care Provider University of Vermont (UVM) (PPO) Vermont Association of Chamber of Commerce Executives (VACE) (PPO) Vermont Health Partnership (VHP) Vermont Health Partnership (VHP) Indemnity Updated 01/27/15 with CBA prefix HIN Indemnity The Vermont Health Plan Vermont Health Partnership Vermont Health Partnership Vermont Health Partnership Vermont Health Partnership Vermont Health Partnership Vermont Health Partnership Indemnity Indemnity (VHP) (VHP) (VHP) (VHP) (VHP) (VHP) CBA Blue Prefixes BCBSVT does the contracting for medical services, durable medical equipment and ancillary providers. Claims for these prefixes must be submitted to CBA Blue directly and should never be submitted to BCBSVT. Customer Service inquiries are answered by CBA Blue staff. Prefix AHW BME CRO CUP HIN HKO KBE KDU KEZ LMM NFI REM RSD SGI SQF VRA Product and/or Account Autumn Harp Northwestern Medical Center Caledonian-Record Pub Co. Correct Care Solutions Total Temperature Instrumentation (Instrumart) Holyoke Medical Center Middlebury College Dunkin’ Donuts CBA PPO Mack Molding NFA Master Trust American Employers Alliance, Inc. Resource Systems Group, Inc. Symquest Group, Inc. Simon Pearce CBA PPO Updated 01/27/15 with CBA prefix HIN New England Health Plan (NEHP) and Access Blue New England (ABNE) Prefixes Claims for NEHP members for services rendered in Vermont are submitted to BCBSVT, unless the provider contracts with both BCBSVT and the New England state where the Primary Care Provider (PCP) is located. In this case, claims for PCP services should be submitted to the PCP state. Care and Case Management, if/when applicable for these prefixes is done by BCBSVT. Radiology, pharmacy, mental health and substance abuse services are not managed by BCBSVT or its partners. The member’s Blue Plan is responsible for quoting benefits. BCBSVT is responsible for questions regarding referrals and/or prior approvals when the PCP is located in Vermont and claim inquiries when claims are submitted to BCBSVT. Prefix CTN CTP EHF EHG EHH EHJ MEN MEP MTN MTP NHN NHP YGE YGI YGL Plan Connecticut Connecticut Connecticut Maine New Hampshire Massachusetts Maine Maine Massachusetts Massachusetts New Hampshire New Hampshire New Hampshire New Hampshire New Hampshire Type NEHP NEHP ABNE ABNE ABNE ABNE NEHP NEHP NEHP NEHP NEHP NEHP ABNE NEHP NEHP Updated 01/27/15 with CBA prefix HIN Name HMO New England HMO New England Access Blue New England Access Blue New England Access Blue New England Access Blue New England New England HMO New England POS HMO New England HMO New England HMO New England HMO New England Access Blue New England Blue Choice New England HMO Blue New England
