Download Most Common ID Card Prefixes for VIRGINIA

2017 MOST COMMON ID CARD PREFIXES FOR VIRGINIA BUSINESS
ID PREFIX
ALPHA
ORDER
IN
HKB
PLAN / PRODUCT NAME
Anthem HealthKeepers
PROVIDER
NETWORK
CONTACT INFORMATION
COMMERCIAL HMO
SILVER X POS
(GATEKEEPER HEALTHKEEPERS)
(SMALL GROUP - ON EXCHANGE - GUIDED ACCESS)*
HKQ
PROVIDER
Anthem HealthKeepers
COMMERCIAL HMO
SILVER AND GOLD X POS
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
(OPEN ACCESS HEALTHKEEPERS)
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
PATHWAY TIERED
HOSPITAL
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
(SMALL GROUP - ON EXCHANGE - OPEN ACCESS)*
XTO
YRC
YRE
----------
VOA
Anthem HEALTHKEEPERS
CATASTROPHIC / BRONZE / SILVER / GOLD- POS
(INDIVIDUAL - OFF EXCHANGE - OPEN ACCESS)*
NARROW NETWORK*
Anthem COMMONWEALTH COORDINATED CARE
DUAL INTEGRATION
(MEDICARE/MEDICAID PLAN / MMP)
(OPEN ACCESS)
Anthem MEDICARE PREFERRED
(MEDICARE ADVANTAGE PPO FOR EMPLOYER GROUP RETIREES)
Claims, Benefits:
—
_________________________________________________________________________________________
Anthem MEDIBLUE ACCESS
Claims, Benefits:
(855) 817-5788
Medical Auths:
(855) 817-5788
Behavioral Health Auths: (855) 661-1988 (24/7)
MEDICARE ADVANTAGE
PPO
(NAME CHANGE EFF. 1/1/16)
Medical Auths:
(866) 845-8609 (M-F 8am-6pm) or
(888) 290-9160 (M-F 8am-8pm)
(866) 797-9884 - Remain on the line;
(disregard the message to call American Imaging Management)
Behavioral Health Auths: (866) 582-2293- “2”=OP; “3”=IP
------------------------------------------------------------------------------------
Claims, Benefits, Medical & Behavioral Health Auths:
(866) 827-9866 (M-F 8am-8pm)
(MA PPO FOR INDIVIDUALS- SOLD ONLY IN MATHEWS COUNTY)
YRV
Formerly YTA – Individual (non-group) only
TRADITIONAL “PAR”
YRW
Formerly YTC – Individual (non-group) only
PPO
YRX
Formerly YTH – Individual (non-group) only
COMMERCIAL HMO
YRZ
Formerly YTP – Individual (non-group) only
PPO
Page 1 of 4
Claims, Benefits:
(800) 533-1120 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
Claims, Benefits:
(800) 533-1120 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
Claims, Benefits:
(800) 533-1120 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
Claims, Benefits:
(800) 533-1120 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: ( 800) 991-6045 (24/7/365)
PLAN / PRODUCT NAME
PROVIDER
PROVIDER
ALPHA
ORDER
NETWORK
CONTACT INFORMATION
YTA
Anthem BLUECARE
TRADITIONAL “PAR”
Claims, Benefits:
(800) 533-1120 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
ID PREFIX
IN
YTB
-----YTB
Anthem HEALTHKEEPERS
BRONZE / SILVER / GOLD / PLATINUM - OA POS
(Small Group - OFF Exchange - OPEN ACCESS)*
------------------------------------------------
COMMERCIAL HMO
(OPEN ACCESS HEALTHKEEPERS)
------------------COMMERCIAL HMO
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
Anthem HEALTHKEEPERS
BRONZE / SILVER / GOLD- POS PLUS
(GATEKEEPER HEALTHKEEPERS)
Anthem LUMENOS (HDHP)
PPO
Claims, Benefits:
(866) 249-7141 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
MEDICAID HMO & FAMIS
Claims, Benefits:
(800) 901-0020 (M-F 8am-6pm)
Medical Auths:
(800) 901-0020 (M-F 8am-5pm)
Behavioral Health Auths: (800) 901-0020 (24/7/365)
(Small Group - OFF Exchange - GUIDED ACCESS)*
YTC
YTD
YTE
YTF
YTG
YTH
YTM
YTN
Anthem
HEALTHKEEPERS PLUS
YTD = Central, Northern, and Western Virginia enrollees
YTE = Peninsula (Eastern) enrollees
YTF = Tidewater (Eastern) enrollees
Anthem HEALTHKEEPERS
(OPEN ACCESS)
COMMERCIAL HMO
(OPEN ACCESS OR GATEKEEPER)
Anthem MEDICARE SUPPLEMENTAL (MEDSUP)
TRADITIONAL “PAR”
Claims, Benefits:
(800) 451-0361 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
PPO
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
Anthem
BRONZE / SILVER / GOLD / PLATINUM - PPO
(Small Group - OFF Exchange)
YTO
YTP
Claims, Benefits:
(800) 533-1120 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
YTG = unique to Anthem employees/dependents
YTH = standard commercial HealthKeepers
CATASTROPHIC / BRONZE / SILVER / GOLD
PATHWAY TIERED
HOSPITAL
(Individual - OFF Exchange - OPEN ACCESS)*
NARROW NETWORK*
Anthem KEYCARE
PPO
Anthem HEALTHKEEPERS
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Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
Claims, Benefits:
(800) 533-1120 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
ID PREFIX
ALPHA
ORDER
IN
YTR
PLAN / PRODUCT NAME
PROVIDER
PROVIDER
NETWORK
CONTACT INFORMATION
Anthem HEALTHKEEPERS
PATHWAY X TIERED
HOSPITAL
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
CATASTROPHIC / BRONZE / SILVER / GOLD X
(Individual - ON Exchange - OPEN ACCESS)*
Anthem HEALTHKEEPERS
NARROW NETWORK*
YTS
YTS = self-insured HMO policies; includes Hanover & Henrico counties
YTT
Anthem HEALTHKEEPERS LUMENOS (HDHP)
COMMERCIAL HMO
YTU
Anthem HEALTHKEEPERS
BRONZE / SILVER / GOLD / PATHWAY X POS
PATHWAY X TIERED
HOSPITAL
YTV
(Small Group - ON Exchange - GUIDED ACCESS)*
COMMERCIAL HMO
NARROW NETWORK*
COVA MEDICARE SUPPLEMENTAL AND
TLC MEDICARE SUPPLEMENTAL
(IF THE TLC GROUP OFFERS COVERAGE)
Claims, Benefits:
Medical Auths:
Behavioral Health Auths:
Claims, Benefits:
Medical Auths:
Behavioral Health Auths:
(800) 533-1120 (M-F 8am-6pm)
(800) 533-1120 (M-F 8am-5pm)
(800) 991-6045 (24/7/365)
(800) 582-6941 (M-F 8am-6pm)
(800) 533-1120 (M-F 8am-5pm)
(800) 991-6045 (24/7/365)
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
PPO
Claims, Benefits:
(800) 552-2682 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (855) 223-9277 (24/7/365)
PPO
Claims, Benefits:
(800) 552-2682 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (855) 223-9277 (24/7/365)
for Medicare eligible RETIREES
YTX
COVA CARE / COVA HDHP AND
TLC KEY ADVANTAGE (X4) / TLC HDHP
for ACTIVES, early RETIREES, and COBRA
YTY
Anthem HealthKeepers
SILVER / GOLD
(Individual - ON Exchange - DIRECT(OPEN) ACCESS)*
(aka Multi-State Plan Program or MSPP)
YTZ
Anthem HealthKeepers
CATASTROPHIC / BRONZE / SILVER / GOLD X POS
(INDIVIDUAL - ON EXCHANGE - OPEN ACCESS)*
PATHWAY X TIERED
HOSPITAL
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
NARROW NETWORK*
PATHWAY X TIERED
HOSPITAL
Claims, Benefits:
(855) 856-9286 (M-F 8am-6pm)
Medical Auths:
(800) 533-1120 (M-F 8am-5pm)
Behavioral Health Auths: (800) 991-6045 (24/7/365)
NARROW NETWORK*
*IMPORTANT NOTES*: ALL INDIVIDUAL ACA/EXCHANGE PRODUCTS ARE OPEN ACCESS (no PCP Referral), SO WILL NOT CONTAIN “OA” IN THE PRODUCT NAME. FOR OTHER THAN THE PPO
ACA/EXCHANGE PRODUCT, SMALL GROUP EXCHANGE PRODUCTS THAT ARE OPEN ACCESS WILL CONTAIN “OA”; OTHERWISE, THE ABSENCE OF “OA” MEANS THESE ARE GUIDED ACCESS (PCP Referral
required); ID CARD WILL CONTAIN THE PCPs NAME WHO IS REQUIRED TO OBTAIN THE REFERRAL. AN “X” IN THE PRODUCT OR NETWORK NAME SIGNIFIES “ON” EXCHANGE AND THE TERM, “NARROW
NETWORK*”, SIGNIFIES OUR ACA/EXCHANGE NARROWER NETWORKS THAT ARE NOT OPEN TO ALL SPECIALISTS; THEREFORE, CONFIRMATION OF PROVIDER PARTICIPATION IS RECOMMENDED.
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Most Common ID Card Prefixes for VIRGINIA Business . . . (continued)
IMPORTANT NOTES:
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DISCLAIMER: ID PREFIXES ARE RECYCLABLE; THEREFORE, ALWAYS VERIFY TO CONFIRM ACCURACY AS MEMBER CONTRACT RENEWAL DATES WILL VARY.
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Regardless of the ID card prefix, whether for Virginia business or not, Virginia providers should submit all “Blue” claims to Anthem in Virginia (the local or “HOST” plan), except:



Under certain circumstances, Northern Virginia providers treating “Blue” members in the Route 123/CareFirst service area may need to file elsewhere. Please refer to the chart in the
Anthem Professional Provider Office Manual section of your provider contract for detailed instructions.
When a Virginia provider treats a “Blue” member whose HOME plan is contiguous to Virginia, e.g. NC, WVA, KY, MD and TN, and the Virginia provider also contractually participates
with that member’s HOME plan, then provider should submit the claim to the member’s plan in accordance with the provider’s contract terms with that HOME plan.
When the back of the member’s ID card specifically instructs providers to file directly to the Member/HOME plan and not to the Local/HOST plan.
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IMPORTANT REMINDER: This prefix list does not include Virginia business considered to be a National Account (i.e., a group that is either headquartered here in VA and has
employees living and working in other states or is headquartered out-of-state with locations here in VA). National Account groups may have opted to customize their prefix rather than
use the typical “YT” scheme, which is the designation given to Virginia by the National Blue Cross and Blue Shield Association in Chicago. Some examples include ‘NNS’ for Newport
News Shipbuilders and ‘GYR’ or ‘GYC’ for Goodyear Tire & Rubber Company.
----------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------Effective 01/01/2010, Local Virginia “large” groups, those with 100-999 employees and who are not National Accounts, can customize their prefixes (previously YTP), upon
enrollment for new businesses, and at renewal for existing businesses.
Effective 01/01/2012, Our Virginia commercial HMO business began migration from one operating platform to another, so all our commercial VA products are on the same
system. If you see a prefix of ‘YTS’, this indicates such a policy. This migration has NO AFFECT on how you handle these HMO members.
Effective 01/01/2013, Our Virginia Medicare Advantage PPO service area changed and became available to EGRs (Employer Group Retirees) and not to individuals as before
(except in a very limited number of VA cities/counties). We also added a Medicare Advantage HMO product called “CareMore” in the Richmond area only at this time.
CareMore members carry an Anthem HealthKeepers ID card with the prefix, ‘YTQCM’. Provider participation is very limited and must be separately contracted through
CareMore directly; these members have no Out-of-Network benefits. IMPORTANT NOTE: Both the Provider and Member Services functions are handled directly by
CareMore’s staff – please see member ID cards for appropriate phone numbers.
Effective 10/01/2013, Our Affordable Care Act/Health Insurance Exchange products (both ON and OFF Exchange) for Individuals and Small Groups (less than 50 employees)
went on sale with a 1/1/14 effective date. HIX Open Enrollment runs through 3/31/14, so some individuals or small groups may not become effective until 2/1, 3/1, 4/1 or
MSPP
5/1/14.
“Multi-State Plan Program” refers to OPM-sponsored plans; it does NOT mean that consumers have health plan coverage for non-emergency care in multiple
states. Consumers must utilize providers and services in their HOME state for regular, routine care.
Effective 11/01/2013, Our Virginia MEDICAID HMO business was moved over to a new operating platform, as well as to a new provider web portal.
Effective 1/01/2014, Our Virginia Affordable Care Act (ACA)/Exchange products became effective. This new line of business introduced some new “NARROW” networks, i.e.
Pathway Hospital Tiered and Pathway X Hospital Tiered, as well as a separate operating platform/claims processing system, and a new separate Provider Call Center.
Effective 4/01/2014, Our Virginia MEDICARE/MEDICAID Dual combo product, “Commonwealth Coordinated Care” began.
Effective 4/01/2014, Certain INDIVIDUAL ONLY (non-group) ID prefixes changed in compliance with a mandate from the National Blue Cross Blue Shield Association (BCBS).
New ID cards were issued w/ these new 3-character alpha prefixes; however, the rest of the digits/characters in the ID # did not change, nor did the benefits.
Effective 1/01/2015, Our INDIVIDUAL Only Medicare Advantage PPO is limited to residents of Mathews County, VA.
Effective 1/01/2016, Certain ID cards will display two (2) PCP copayment amounts: the lower copay is when seeing “EPHC” PCPs / the higher copay is for non-EPHC PCPs.
Also, for ACA/Exchange products, SMALL GROUP has been redefined to mean up to 100 employees.
EFFECTIVE 1/1/2017: NO CHANGES IN 2017 FROM 2016 for ACA/Exchange Individual & Small Group (ISG) products.
Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are
independent licensees of the Blue Cross Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
UPDATED: 28December2016/kcn
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