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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 Page 2 of 4 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. Page 3 of 4 Most Common ID Card Prefixes for VIRGINIA Business . . . (continued) IMPORTANT NOTES: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- DISCLAIMER: ID PREFIXES ARE RECYCLABLE; THEREFORE, ALWAYS VERIFY TO CONFIRM ACCURACY AS MEMBER CONTRACT RENEWAL DATES WILL VARY. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- 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. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 Page 4 of 4