Chapter 1- General Information - Premera Blue Cross

Premera Reference ManualPremera Blue Cross Blue Shield of Alaska1 General InformationDescriptionThis chapter provides general contact information about Premera Blue Cross Blue Shield ofAlaska.Topics Section 1: About Premera Blue Cross Blue Shield of AlaskaSection 2: Contact Information – Plans and DepartmentsSection 3: Service Teams – Where to Obtain Assistance023665 (05-2012) General Information Chapter 1 ⎯ Page 1

Premera Reference ManualPremera Blue Cross Blue Shield of AlaskaSection 1: About Premera Blue Cross Blue Shield of AlaskaHistoryWe have provided Alaska residents with access to quality healthcare products andexceptional service for more than 50 years.In Washington, Premera Blue Cross Blue Shield of Alaska operates as Premera Blue Cross.DescriptionAffiliatedCompaniesPremera Blue Cross Blue Shield of Alaska:• Is an independent licensee of the Blue Cross Blue Shield Association• Offers plans in all boroughs of Alaska• Has a network of more than 2000Alaska healthcare professionals and 18 hospitalsAffiliated companies:• LifeWise Health Plan of Oregon• LifeWise Health Plan of Washington• Premera Blue CrossAlaskaMain Office:Denali Towers2550 Denali , Suite 1400Anchorage, AK 99503Mailing Address:Premera Blue Cross Blue Shield of AlaskaP.O. Box 240609Anchorage, AK 99524-0609Call Premera Blue Cross Blue Shield of Alaska – 800-722-4714 – and then select one of thefollowing phone options to reach the department or person you need:0… To speak with an operator1… To reach the direct extension of a Premera employee2… To obtain claims status, eligibility or benefit information (via Customer Service orself-service integrated voice recognition line IVR)3… To speak with Care or Case Management (for inpatient admission notifications,medical necessity questions or case management referrals)4… To reach Physician and Provider Relations (dental or medical)5… Website (questions or to report technical problems)MountlakeTerrace(Seattle)Headquarters:Premera Blue Cross7001 220 th Street SWMountlake Terrace, WA 98043-2124Mailing Address:P.O. Box 327Seattle, WA 98111-0327SpecialNoteThe addresses above are for general correspondence purposes only.For claims submission, use the address printed on the back of the member’s ID card.Questions concerning claims adjudication and payment, member eligibility and benefitsshould be directed to the member’s Customer Service department (phone number printedon the back of the ID card) or by calling 800-722-4714, option 2.General Information Chapter 1 ⎯ Page 2

Premera Reference ManualPremera Blue Cross Blue Shield of AlaskaSection 2: Contact Information – Plans and Departments Global Heritage Plus Heritage SelectBlueCard HostEligibilityPlans Customer Service Claims Address Dimensions ‣800-722-4714, option 2 Send Claims & Correspondence to:P.O. Box 240609Anchorage, AK 99524-0609 State/Federal/Other ‣888-261-9562800 676-BLUE (2583)Send Claims & Correspondence to:P.O. Box 240609Anchorage, AK 99524-0609Federal Employee Program (FEP) 800-562-1011 Send Claims & Correspondence to:P.O. Box 240489Anchorage, AK 99524-0489National Account Service Company(NASCO)800-713-5373 Send Claims & Correspondence to:P.O. Box 240609Anchorage, AK 99524-0609Department Telephone Address Physician and Provider Relations ‣Physician and Provider Relations 800-722-4714, option 4Calypso (excludes NASCO/BlueCard) Customer Solutions/Recovery Subrogation Case ManagementFax: 425-918-4937 Miscellaneous ‣800-364-2991; Fax: 425-918-4722888-704-0638; Fax: 425-918-5878Care Management 800-722-4714, option 3Fax: 800-866-4198 or 800-843-1114Electronic Claims (EDI) 800-435-2715Fax: 425-918-4234Physician and Provider Appeals Contact the Customer Service numbernoted on the back of member’s ID card Non-FEPFax: 425-918-5592 FEPFax: 425-918-6273P.O. Box 327 – MS 453Seattle, WA 98111-0327P.O. Box 327 – MS 229Seattle, WA 98111-0327P.O. Box 327 – MS 227eSeattle, WA 98111-0327P.O. Box 327 – MS 438Seattle, WA 98111-0327P.O. Box 327 – MS 281Seattle, WA 98111-0327P.O. Box 91102Seattle, WA 98111-9202P.O. Box 91058Seattle, WA 98111-9158 Non-Blue Cross Blue Shield Plans ‣LifeWise Health Plan of Oregon 800-596-3440 P.O. Box 7709Bend, OR 97708-7709LifeWise Health Plan of Washington 800-592-6804 P.O. Box 91059Seattle, WA 98111-9159If you have questions about: A member’s benefit, eligibility and claim status or payment, contact Customer Service.Reminder: Eligibility and benefit information given by phone does not constitute an authorization, anddoes not guarantee payment. Actual payment is subject to the patient’s contract and eligibility at thetime of service. For provider changes, contract status or requests, contact Physician and Provider Relations.General Information Chapter 1 ⎯ Page 3

Premera Reference ManualPremera Blue Cross Blue Shield of AlaskaSection 3: Service Teams − Where to Obtain AssistanceBlueCard ® : This program allows national account members of other Blue Cross and/or Blue Shield plans toobtain healthcare services in another Blues plan’s service area via a single electronic network for claimsprocessing and reimbursement. For BlueCard inquiries, contact this department directly at 888-261-9562.Calypso (excludes NASCO). This department processes refunds for overpayments. Contact CalypsoCustomer Solutions/Recovery at 800-364-2991, or P.O. Box 327, Mail Stop 229, Seattle, WA 98111-0327.For inquiries regarding subrogation call 888-704-0638, or mail to P.O. Box 327, MS 227 Seattle, WA98111-0327.• Refund request letters/forms • Overpayments • Subrogation Case ManagementOperations TeamsCustomer Service: Customer Service Representatives (CSRs) answer questions about claims and member’sbenefits and eligibility. You can reach a CSR by calling 800-722-4714, option 2. Have the member IDnumber ready to expedite your call. For claims issues, please have a few examples on hand to facilitate ourinvestigation. CSRs answer questions about:• Member eligibility • Member benefits • Payment voucher/remittance advice• Claims status/adjudication • Claims paymentElectronic Claims: For questions about electronic claims or to become an electronic claims submitter,contact an Electronic Commerce Representative at 800-435-2715, or via e-mail at EDI@premera.com.Interactive Voice Response (IVR): This system provides self-service member information for all plans andDimensions claims status data. IVR is accessible around the clock. Call 800-722-4714, option 2 to connectto the IVR system. Providers can call also 800-722-4714, option 3 to access the Care Management IVRsystem.Prompt Pay: Handles interest related questions. Contact this team at 800-932-2883 for inquiries about:• Amount of interest paid • Voucher interestpayment• Application of an interest paymentHealth Care Delivery Systems (HCDS) TeamsProvider Network Executive (PNE) & Provider Network Associate (PNA): Each contracted physician,dentist, facility, practitioner, ancillary provider and vendor is assigned to a PNE or PNA in HCDS. Call 800-722-4714, option 4 and we’ll connect you with your PNE or PNA. Duties include:• Hospital/facilitycontracting• Policies & procedures • Acting as a liaison to your office• Practitioner contracting • Network adequacy • Facilitating your interactions withPremeraProvider Network Representative (PNR): The PNR team enhances our service by quickly handling yourrequests and resolving non-claims issues. To reach a PNR, contact Physician and Provider Relations at800-722-4714, option 4. We can assist you with:• Contract status inquiries • Panel updates • How to access Premera’s Provider Portal• Address changes • Tax ID number updates • Question on a physician/provider mailing• Telephone number changes • Clinic opening or closing • Practitioner/dental retirement, etc.• Malpractice insurancechanges• Directory copy requests • Document copy requests (e.g., NewsBriefs, Network News, manuals, etc.)• Additions to your clinic • OneHealthPortGeneral Information Chapter 1 ⎯ Page 4

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