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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
Centricity Business-Version 2.2
09/2017
Insurance Cards
Centricity Business/IDX
This document is available on the Clinical Applications website
http://rowan.edu/som/ist/physiciansys.html
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
Centricity Business-Version 2.2
09/2017
INTRODUCTION
The Clinical Applications Department has developed the Insurance Pictionary as a reference guide for users when entering insurance information in Centricity Business/IDX. This information will be updated periodically. The insurance products are listed alphabetically. Each card will list the corresponding CB/IDX-FSC and FSC-Mnemonic. The Table of Contents will list the page numbers detailing how to use the Pictionary and the insurance company product names. In an effort to maintain the most relevant insurance card copies within the training documentation, we request the following (should you receive an insurance card that has not been incorporated and/or a newer version): EMR Users
The insurance card should be scanned into the EMR
Document Type: Internal Other
Create Helpdesk Ticket via email to Centricity Business (IDX) email [email protected]
Include: Patient’s Name, Date of Birth (DOB), and Medical Record Number (MRN) Non-EMR Users
Copy the insurance card
Create electronic version (scan to your RowanSOM email address)
Create Helpdesk Ticket via email to Centricity Business (IDX) email [email protected]
Attach Electronic version of the insurance card
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
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09/2017
TABLE OF CONTENTS
INTRODUCTION ............................................................................................................................... 2
AARP .................................................................................................................................................... 7
AETNA COMMERCIAL/PPO/POS……………………………………………………………….8
AETNA HMO ………………………………………………………………………………………..9
AETNA TPA ………………………………………………………………………………………..10
AETNA MEDICARE ………………………………………………………………………………11
AETNA - (SUMMARY PAGE) ................................................................................................. …. 12
UNITED HEALTHCARE COMMUNITY PLAN (FORMERLY AMERICHOICE PA HMO) ............................................................................................................................................................. 13
AMERIHEALTH ADMINISTRATORS ........................................................................................ 14
AMERIHEALTH HMO/POS OF NEW JERSEY ........................................................................ 15
AMERIHEALTH PPO OF NEW JERSEY ................................................................................... 16
AMERIHEALTH COMMUNITY ADVANTAGE ........................................................................ 17
(FORMERLY AMERIHEALTH VALUE NETWORK) .................................................................. 18
AMERIHEALTH - (SUMMARY PAGE) ...................................................................................... 19
AMERIGROUP – MEDICAL ASSISTANCE ............................................................................... 20
BC/BS OVERVIEW…………………………………………………………………………….21-22
BC/BS FEDERAL BLUE CROSS BLUE SHIELD ....................................................................... 23
BC/BS HORIZON (TRADITIONAL) ............................................................................................ 24
BC/BS HORIZON (NATIONAL) .................................................................................................... 25
BC/BS HORIZON (EPO) ................................................................................................................. 26
BC/BS HORIZON BLUE CHOICE ………………………………………………………………27
BC/BS HORIZON (HMO & MEDICARE BLUE) ........................................................................ 28
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
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BC/BS HORIZON NJ HEALTH NJMA …………………………………………………………29
HORIZON NJ TOTAL CARE PROVIDER QUICK REFERENCE GUIDE……………..30-35
BC/BS HORIZON - (SUMMARY PAGE) ..................................................................................... 36
HORIZON BC/BS ………………………………………………………………………………37-38
BC/BS IBC/PA BS SECONDARY .................................................................................................. 39
BC/BS IBC/PA BS 65 SPECIAL & SECURITY 65 ...................................................................... 40
BC/BS IBC/PERSONAL CHOICE 65 ............................................................................................ 41
BC/BS IBC PLANS SUMMARY PAGE …………………………………………………………42
CIGNA PLANS ................................................................................................................................. 43
COMMERCIAL INSURANCE ....................................................................................................... 44
DEVON .............................................................................................................................................. 45
HEALTHNET ................................................................................................................................... 46
INTERGROUP/BEECHSTREET ………………………………………………………………..47
KEYSTONE HMO/KEYSTONE 65 ............................................................................................... 48
INDEPENDENCE BC/BS ……………………………………………………………..............49-50
(MA) NEW JERSEY MEDICAL ASSISTANCE (NJMA) .......................................................... 51
(MA) MEDICAL ASSISTANCE (SUMMARY PAGE) ............................................................... 52
MAGACARE ……………………………………………………………........................................53
MAGELLAN BEHAVIORAL HEALTH ....................................................................................... 54
MEDICARE/RAILROAD MEDICARE ........................................................................................ 55
MEDICARE REPLACEMENT PLANS (SUMMARY PAGE) ................................................... 56
MULTIPLAN .................................................................................................................................... 57
OXFORD ........................................................................................................................................... 58
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PREFERRED HEALTH NETWORK (MAX) ............................................................................... 59
QUALCARE ...................................................................................................................................... 60
THIRD PARTY ADMINISTRATORS (TPA) ............................................................................... 61
CHAMPUS (TRICARE) .................................................................................................................. 62
UNION INSURANCE (LOCAL UNIONS) .................................................................................... 63
UNITED BEHAVIORAL HEALTH ……………………………………………………………..64
UNITED HEALTHCARE/GOLDEN RULE ……………………………………………………65
UNITED HEALTHCARE GROUP - (SUMMARY PAGE) ......................................................... 66
US FAMILY HEALTH PLAN ........................................................................................................ 67
VALUE OPTIONS BEHAVIORAL HEALTH ............................................................................. 68
VETERANS ADMINISTRATION ................................................................................................. 69
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
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09/2017
HOW TO USE THE PICTIONARY
The pictionary is intended to aid in the selection of the correct Financial Status Classification (FSC) in CB/IDX. If you are not able to find the assistance you need in this document, you may send an email to [email protected] for assistance. Copies of insurance cards have been scanned into this document and sorted in alphabetical order by insurance company name at the beginning of the section for each carrier included in the pictionary. Whenever possible, this document will give the user general information about the insurance carrier and the types of plans offered by that carrier. Cards will be presented in alphabetical order and then sorted by plan type (HMO, PPO, Indemnity/Commercial) when appropriate. Every effort has been made to include sample cards from as many carriers as possible. However, not every insurance plan available to the public or sample card for every carrier plan could be included. Search alphabetically to find the page or section of this document containing copies of the insurance cards for the insurance company that issued the patient’s policy. Please locate the copy of the card or the most similar to the card presented by the patient when applicable. The IDX-FSC and FSC-Mnemonic will be displayed for use when entering the patient’s insurance information within the various systems. Please read all sides of the card or call the carrier to obtain the correct address for claims submission. RowanSOM Implemented the Eligibility Module in November 2013; as a result, a column has been added indicating if the insurance is, Eligibility enabled Yes/No (Y/N). IDX Users When applicable users must search and select the insurance company address from the insurance dictionary to ensure timely electronic filing.
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
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AARP
AARP - Medigap Coverage (patient pays for coverage): If a Medicare patient has supplemental insurance that is not offered by a former employer to help cover non-reimbursable charges, deductibles, and co-insurance, this insurance is called medigap. AARP - Primary Insurance Plans (Benefit Alert) AARP primary coverage plans provide limited benefits.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
AARP (after Medicare) 50 CIM Y
AARP (Primary Coverage)-Commercial Insurance 41 CI Y
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AETNA COMMERCIAL/PPO/POS
FSC 40
FSC 48 FSC 40
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AETNA COMMERCIAL (INDEMNITY, CHOICE POS, PPO)
40 AHP Y
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AETNA HMO
FSC 48
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
AETNA HMO 48 USH Y
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AETNA TPA
Government Employees (GEHA) 462
Aetna Signature Administrators (TPA). Third Party Administrator (TPA): Third Party Administrators serve as PPO Networks. TPAs provide administrative services to small employer groups and/or self funded Health Organizations; they re-price the claims to ensure the best payment rate. Benefit limitations may apply.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
AETNA TPA (Aetna Signature Administrators) 462 ATPA N
Member Name: Participant, John Identification#: Varies per Employer Phone Number: Review Insurance Card Claims Address: Review Insurance Card
Employer’s Logo
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
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AETNA MEDICARE
FSC 848 FSC 840
Note: Aetna Medicare plan will always have an ID number that starts with “ME” followed by a number.
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AETNA GOLDEN MEDICARE (HMO) 848 AEMA Y
AETNA MEDICARE ADVANTAGE (PPO) 840 AEMP Y
AETNA MEDICARE PRIME (NON-PAR) 888 MRA N
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AETNA - (SUMMARY PAGE)
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AETNA HMO – POS 48 USH Y
AETNA Commercial-INDEMNITY, PPO, EPO (i.e. Non HMO) 40 AHP Y
AETNA MEDICARE (HMO) 848 AEMA Y
AETNA ADVANTAGE (PPO) 840 AEMP Y
AETNA MEDICARE PRIME (NON-PAR) 888 MRA N
AETNA TPA (Aetna Signature Administrators) 462 ATPA N
AETNA BETTER HEALTH – Medicaid 41 CI N
AETNA BEHAVORIAL HEALTH – RowanSOM GRP#3 375 AEB N
AETNA BEHAVORIAL HEALTH – RowanSOM GRP#4 675 ABH N
AETNA BEHAVORIAL HEALTH – RowanSOM GRP#7 775 AEBH N
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
Centricity Business-Version 2.2
09/2017
UNITED HEALTHCARE COMMUNITY PLAN (FORMERLY AMERICHOICE PA HMO)
United Community Plan Behavioral Health is provided by Optum for developmental disabilities and long term care. Rowan is currently non-participating with Optum. All other behavioral health services are to be processed by NJMA.
PLAN DESCRIPTION FSC # FSC Mnemonic EligibilityEnabled
UNITED HEALTHCARE COMMUNITY PLAN (formerly Americhoice of New Jersey) 451 ACNJ Y
UNITED HEALTHCARE COMMUNITY PLAN 2NDRY (formerly Americhoice of New Jersey)
207 AC2 Y
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AMERIHEALTH ADMINISTRATORS
.
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AMERIHEALTH ADMINISTRATORS INDEPENDENCE ADMINISTRATORS
435 AMA Y
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AMERIHEALTH HMO/POS OF NEW JERSEY
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AMERIHEALTH HMO 77 DVH Y
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AMERIHEALTH PPO OF NEW JERSEY
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AMERIHEALTH PERSONAL CHOICE PPO 161 PC Y
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AMERIHEALTH COMMUNITY ADVANTAGE (FORMERLY AMERIHEALTH VALUE NETWORK)
Note: CB/IDX System re-labeling of this FSC will occur during the Fiscal Year End process July 2014.
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AMERIHEALTH COMMUNITY ADVANTAGE Formerly Amerihealth Value Network (Cooper Advantage or Tier 1 and Tier 2 Advantage) EPO
461 AVN Y
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
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AMERIHEALTH - (SUMMARY PAGE)
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AMERIHEALTH HMO/POS 77 DVH Y
AMERIHEALTH PERSONAL CHOICE PPO 161 PC Y
AMERIHEALTH ADMINISTRATORS 435 AMA Y
AMERIHEALTH MEDIGAP (Secondary to Medicare) 30 P65 Y AMERIHEALTH COMMUNITY ADVANTAGE Formerly Amerihealth Value Network (Cooper Advantage or Tier 1 and Tier 2 Advantage)
461 AVN Y
AMERIHEALTH HMO/POS EXPIRED 80 DVE N
AMERIHEALTH PERSONAL CHOICE PPO EXPIRED 341 PCE N
AMERIHEALTH ADMINISTRATORS EXPIRED 436 AME N
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*Q1B – Has been assigned to multiple product lines. Users must review the plan type rendered on the electronic validation tool to ensure the correct FSC
has been utilized. Additionally, patients presenting for service with the EPO plan insurance cards will list the Community Advantage or Tier 1 Advantage logos.
Prefix/Suffix
Plan Type
IDX-FSC
FSC
Mnemonic
Telephone
Physician
Claims Address
Q1C,Q2C,Q3B,Q3C HMO 77 DVH 215-241-2400 PO Box 41574
Philadelphia, PA 19101-1574
Q1P ,Q2P, Q3A,Q3P POS 77 DVH 215-241-2400 PO Box 41574
Philadelphia, PA 19101-1574
Q1H,Q1S,Q1T,Q2B *Q1B
PPO, PPO-HSA POS-PLUS
Major-Medical 161 PC 215-241-2400
PO Box 41574 Philadelphia, PA
19101-1574
*Q1B
EPO EPO-HAS
Community Advantage Tier 1 and Tier 2
Advantage
461 AVN 215-241-2400 PO Box 41574
Philadelphia, PA 19101-1574
Q1E
Amerihealth Medigap (Secondary to Medicare)
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P65 215-241-2400
PO Box 898845 Camp Hill, PA
17089-8845
Suffix = (TPA) PPO 436 AMA 215-241-2400 PO Box 21545
Eagan, MN 55121
Amerihealth Prefix/Suffix IDX-FCS Table
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2013 Rowan University School of Osteopathic Medicine Information Resources and Technology Clinical Systems Department
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AMERIGROUP – MEDICAL ASSISTANCE
*NON PAR FOR OFFICE APPOINTMENTS
PLAN DESCRIPTION FSC # FSC MnemonicEligibilityEnabled
AMERIGROUP 41* AMG Y
AMERIGROUP 2NDRY 209* AM2 Y
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Blue Cross/Blue Shield Overview
The Blue Cross and Blue Shield Association is the trade association for the oldest and largest group of health insurance companies in America. It is comprised of 44 independent, locally operated companies. These plans are located in 50 states, the District of Columbia, Puerto Rico and Internationally and offer a variety of insurance products to all segments of the population, including individuals, small businesses, seniors and large employer groups. The Blue Cross plan pays for hospital charges and the Blue Shield plan pays physician charges. If the patient’s insurance card only indicates Blue Cross ask them if they have any additional insurance coverage to pay for the physician services. The Alpha prefix and Blue Cross Blue Shield Plan Codes are the key elements used to identify and route the area claims. The prefix identifies the plan (by geographical area) or national account to which the member belongs. Blue Cross pays for Hospital services Blue Shield pays for Physician services You must first determine the type of Blue Cross/ Blue Shield coverage the patient has and then select the appropriate IDX-FSC(s) Participating Blue Cross/ BlueShield Plans RowanSOM participates with the following Blue Cross/ BlueShield Plans Horizon Blue Cross Blue Shield of New Jersey Plan Codes 780/280 Blue Cross Blue Shield Federal Plan The Federal Blue Cross Blue Shield Plan can be identified by the single alpha prefix character R and must be billed to the local Plan Horizon (BC/BS)
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BC/BS HORIZON BLUE CROSS BLUE SHIELD
In Mid November 2005, Horizon Blue Cross Blue Shield of New Jersey converted the Member Identification Number from the Social Security Number to a 15 character Unique Identification Number. The new Identification Number will retain the three-letter Alpha-prefix which is required to ensure smooth claim submission. As existing patients present for care with cards, upon insurance verification; certified users must update the account reflecting the new information. Users, who do not physically view cards, be sure to ask the patient to read the complete ID number or contact Horizon at 800-624-1110. The new ID format is described below.
Position 1-3: Alpha Prefix Position 4: Numeric Position 5-7: Alpha Numeric Position 8-14: Numeric Position 15: will always be zero (0)
Attached you will find the updated Horizon Alpha Prefix Grids which includes Alpha prefixes for Local Unions. Horizon Blue Cross Blue Shield of New Jersey is one of the designated insurance carriers for the Local Unions. Horizon Blue Cross Blue Shield of New Jersey members can be identified by the BC/BS Plan Codes 280/780 on their insurance identification cards. Patients presenting for service with Plan Codes 280/780 must be registered according to the attached Alpha Prefix Grid. Patients presenting with Plan Codes other than Horizon BC/BS of NJ 280/780 with the respective FSC.
Suitcase logo
The BlueCard Program links participating health care providers and the independent Blue Cross and/or Blue Shield Plans across the country and abroad with a single electronic network for claims processing and reimbursement.
Members whose ID cards display the PPO in the suitcase logo and are traveling or reside outside their Plan’s service area receive PPO-level benefits when they need services from participating physicians and other health care professionals.
Members whose ID cards display the blank suitcase logo may be enrolled in a product other than PPO.
Members whose ID cards do not display a suitcase logo are excluded from receiving benefits through the BlueCard Program.
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BC/BS FEDERAL BLUE CROSS BLUE SHIELD
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
Federal BC/BS (Prefix – R) 21 NJBS Y
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BC/BS HORIZON (TRADITIONAL)
* Only use FSC 54 when patient has (2) Horizon Plans. Not to be used after Medicare.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Horizon BC/BS Traditional, PPO, 21 NJBS Y
Horizon BC/BS Traditional, PPO, Secondary 54* NB2 Y
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BC/BS HORIZON (NATIONAL)
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Horizon BC/BS Commercial 24 NBS Y
Horizon BC/BS Secondary 54 NB2 Y
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BC/BS HORIZON (EPO)
Horizon Advanced EPO RowanSOM has entered into an agreement with Horizon Blue Cross Blue Shield (BC/BS) regarding the Horizon Advanced EPO Plan. Patients with this product may elect to have a Primary Care Physician (PCP) coordinate their medical care. When the patient has selected a RowanSOM Provider as their PCP; services rendered will be reimbursed based on capitation rather than Fee‐For‐Service rates. Currently, the Pulmonary and Sports Medicine Groups are considered non‐participating. Users within this area will not be able to retrieve referral information. New FSCs have been instituted in conjunction with this initiative. The Alpha prefixes listed below do not constitute the entire of list of Horizon EPO prefixes. Always validate the patient’s coverage including plan type and PCP selection to ensure the appropriate FSC has been selected. Effective January 1, 2014, patients presenting with this product should be registered as described below. Users will continue to submit claims to the address listed in the insurance dictionaries.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Horizon BC/BS EPO (Non-RowawSOM PCP) 31 NJEPO Y
Horizon BC/BS EPO CAP REG (RowanSOM PCP Selection) 33 HCR Y
Alpha Prefix IDX‐FSC FSC Name
FSC Mnemonic
FSC Type
JGA, JGB, JGC, JGD, JGE, JGF, JGG, JGH, JGI, JGJ, JGL, JGM, JGR, JGS, JGV, JGW, JGX, JGY, JGZ 31 Horizon EPO NJEPO
Registration Non‐Capitated
JGV, YKH 33 Horizon EPO CAP REG HCR Registration Capitated
JGV, YKH 34 Horizon EPO CAP INV HCI Invoice
Capitated
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BC/BS Horizon Blue Choice
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Horizon Blue Choice 156 BC Y
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BC/BS HORIZON (HMO & MEDICARE BLUE)
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Horizon HMO BLUE 74 MGP Y
Horizon MEDICARE ADVANTANGE 874 HOMA Y Horizon NJ MEDICARE ADVANTAGE DIRECT
876 HMAP Y
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BC/BS Horizon NJ Health NJMA
* FSC 208 is only used when patient has Medicare or MRA as Primary.
Users should not enter the alpha (if any) prefix listed on the card for patients presenting with this product.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Horizon NJ Health (NJMA) Formerly Horizon Mercy 96 MHP Y
Horizon NJ Health (NJMA) 2NDRY 208* MH2 Y
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BC/BS HORIZON - (SUMMARY PAGE)
The system will not allow the second plan to be added with its assigned FSC number.
The second plan should be added using FSC 54 (NJ Blue Shield Second).
Union Employee Health coverage based on number of hours worked per month
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Federal BC/BS (Prefix - R) Plan 21 NJBS Y
Horizon BC/BS Traditional, PPO, EPO Plans 21 NJBS Y
Horizon BC/BS National Plan 24 NBS Y
Horizon BC/BS EPO (Non-RowanSOM PCP) 31 NJEPO Y
Horizon BC/BS EPO CAP REG (RowanSOM PCP Selection) 33 HCR Y
Horizon Blue Choice 156 BC Y
Horizon BC/BS HMO Blue Plan 74 MGP Y
Horizon BC/BS Medicare Blue Plan (HMO) 874 HOMA Y
Horizon BC/BS (65 special & Security 65) Medigap 29 N65 Y
HORIZON MEDICARE ADVANTAGE PPO 876 HMPA Y
*Horizon BC/BS (Secondary Plans) 54 NB2 Y
NJ Carpenters’ Primary Local Prefix ZJP 21 NJBS N
NJ Teamsters’ Primary Local Prefix TWP 21 NJBS N
Horizon BC/BS Local Prefix HUF & HWX 24 NBS N
Horizon NJ Health (NJMA) Formerly Horizon Mercy Plan 96 MHP Y
Horizon NJ Health (NJMA) 2NDRY 208 MH2 Y
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Prefix
Plan Type
IDX-FSC
FSC
Mnemonic
Telephone
Physician
Claims Address
YHC, YHU, YHS, YHQ NJT - NJTransit
Commercial 21 NJBS 800-624-1110 PO Box 1609 Newark, NJ 07101-1609
R, 8-Digits & PPO Logo
(Federal Employees) Commercial 21 NJBS 800-624-1110
PO Box 656 Newark, NJ 07101-1609
FMA, FMR, NCH, YHF, YHN, HIF, HSG
Commercial 21 NJBS
800-624-4758
PO Box 247 Newark, NJ 07101-0247
NGM, DEH, DMM, DTM, DTP, NGM, GMM
General Motors/Delphi Auto
Commercial
24 NBS
800-452-1396 P O Box 639 Newark, NJ 07101-0637
FMA, FMR Ford Motor Company
Commercial 21 NJBS
800-624-4758
P O Box 247 Dept V.
Newark, NJ 07101-0247 ATT, AYA, LTI, AT&T
Avaya, Lucent Technology Members
Blue Choice
156
BC
800-624-1110
PO Box 728 Newark, NJ 07101-0728
YHD, YHG, YHP, YHH & ALL other POS
members
Blue Choice
156
BC
800-624-1110
PO Box 820 Newark, NJ 07101-0820
NJX – NJ State Health Benefit Program
Commercial 21 NJBS 800-624-1110 PO Box 820 Newark,
NJ 07101-0820
Horizon Blue Cross Blue Shield Prefix/Suffix IDX-FCS Table
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Prefix
Plan Type
IDX-FSC
FSC
Mnemonic
Telephone
Physician
Claims Address
JGK, JGY, JGW,
JGX,JGZ
(EPO & EPO Plus) Non-Capitated
31 NJEPO 800-624-1110
PO Box 1609 Newark, NJ 07101-1609
JGV, YKH (EPO & EPO Plus)
Capitated 33 HCR 800-624-1110
PO Box 1609 Newark, NJ 07101-1609
NHC, HSG, HWW, HWA
Commercial 21 NJBS 800-624-1110 PO Box 1609 Newark, NJ 07101-1609
JGA, JGD, JGG, JGF
(Consumer Directed Healthcare)
21 NJBS 800-624-1110 PO Box 1609 Newark, NJ 07101-1609
Local Union TWP, ZJP
PPO 21 NJBS 800-624-1110 PO Box 1609 Newark, NJ 07101-1609
Local Union HUF, HWX
PPO
24 NBS 800-452-1396
PO Box 1301 Neptune, NJ
07754
YHM,YHO HMO 74 MGP 800-624-1110 PO Box 820 Newark, NJ 07101-0820
YHT,YKB,YKD, YKN,YHV,YKI,YKO,
YKM, YKK Medicare Advantage 874 HOMA 800-624-1110
PO Box 1609 Newark, NJ 07101-1609
YHR, YHW Medicare Supplemental 29 N65 800-624-1110
PO Box 1184 Newark, NJ 07101-1184
Horizon NJ Health (NJMA)
NJ Medical Assistance 96 MHP 877-765-4325 PO Box 7117
London, KY 40742
Horizon Blue Cross Blue Shield Prefix/Suffix IDX-FCS Table
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BC/BS IBC/PA BS SECONDARY
Used when Medicare is not the primary coverage
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
PA B/S 2ND 55 PB2 Y
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BC/BS IBC/PA BS 65 SPECIAL & SECURITY 65
Used when Medicare is Primary
PLAN DESCRIPTION FSC # FSC
MnemonicEligibility Enabled
PA 65 SPECIAL 30 P65 Y
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BC/BS IBC/PERSONAL CHOICE 65
PLAN DESCRIPTION FSC #FSC
Mnemonic EligibilityEnabled
PERSONAL CHOICE 65 MEDICARE ADVANTAGE 861 PCMA Y
PC65 MEDICARE ADVANTAGE EXPIRED 862 PCME N
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BC/BS IBC Plans – Summary Page
*IBC/PA BS Secondary Plans
FSC 54 – is used when Medicare is not the Primary payer.
FSC 30 – is used when Medicare is the Primary payer
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
PA B/S 2ND 55 PB2 Y
PERSONAL CHOICE 65 MEDICARE ADVANTAGE 861 PCMA Y
PA 65 SPECIAL 30 P65 Y
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CIGNA PLANS
There was a request to add another FSC to designate Cigna HMO vs Cigna PPO. Could this be incorporated in this document?
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
CIGNA 56 CIG Y CIGNA BEHAVIORAL HEALTH RowanSOM GRP#4 701 CBH N
CIGNA BEHAVIORAL HEALTH RowanSOM GRP#7 776 CIGB N
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COMMERCIAL INSURANCE
Commercial Insurance Primary is used when the insurance carrier for the primary commercial insurance coverage does not have designated FSCs.
Commercial Insurance Secondary is used if the patient has two commercial insurance
plans that do not have designated FSCs Commercial Insurance Secondary cannot be assigned before a primary insurance coverage FSC has been assigned.
Commercial Insurance After Medicare is used when the patient has Medicare primary
and secondary or supplemental coverage
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
COMMERCIAL-Primary 41 CI N COMM INSUR-2NDRY 44 CIS N
COM INS AFT MEDICARE 50 CIM N
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DEVON
Devon Health Care Network (TPA). Third Party Administrator (TPA): Third Party Administrators serve as PPO Networks. TPAs provide administrative services to small employer groups and/or self funded Health Organizations; they re-price the claims to ensure the best payment rate. Benefit limitations may apply.
PLAN DESCRIPTION FSC # FSC
MnemonicEligibility Enabled
DEVON/AMERICARE 165 AMRC N
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HEALTHNET
FSC 50 CIM PAYER ID# 06108
FSC 44 CIS
FSC 84 CI3
PLAN DESCRIPTION FSC # FSC
MnemonicEligibility Enabled
HEALTHNET PPO 41 HEAP N
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INTERGROUP/BEECHSTREET
InterGroup Services Corporation (TPA). Third Party Administrator (TPA): Third Party Administrators serve as PPO Networks. TPAs provide administrative services to small employer groups and/or self funded Health Organizations; they re-price the claims to ensure the best payment rate. Benefit limitations may apply.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
INTERGROUP 454 ITG N
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INDEPENDENCE BC KEYSTONE HMO/KEYSTONE 65
PLAN DESCRIPTION FSC # FSC
MnemonicEligibility Enabled
KEYSTONE HMO 452 KHP Y KEYSTONE HP EAST EXPIRED 456 KHPE N
KEYSTONE 65 MEDICARE 852 KEMA Y
KEYSTONE 65 MCR EXPIRED 853 KMCE N
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Prefix/Suffix
Plan Type
IDX-FSC
FSC
Mnemonic
Telephone
Physician
Claims Address
QCH,QCL,YXQ YXW, YXZ
(formerly – YXH,YXE) Keystone - HMO 452 KHP 215-241-2400
PO Box 69353 Harrisburg, PA
17106-9353
QCG,QCJ,YXR (formerly – YXG,YXJ)
Keystone - POS
452 KHP 215-241-2400 PO Box 69353 Harrisburg, PA
17106-9353 CNS,DQU,DVK,EQJ,FJM
FYP,GJF,GJJ,GKV,GSN,IKE IKF,IKM,IXU,LUF,MFL,MGA
MGG,OBW,OCQ,OMJ,OPY,PBX PRP,PUQ,SNC,UJX,WUF,YXA
YXL,YXT
Independence Administrators TPA 435 AMA 215-241-2400 PO Box 21974
Eagan, MN 55121
QCI,QCK (formerly – YXC,YXI)
Keystone65 (Medicare Replacement Plan)
852 KEMA 215-241-2400
PO Box 69353 Harrisburg, PA
17106-9353
YXF,YXO,YXP,YXU (formerly – QCB)
Personal Choice - PPO
161 161 215-241-2400
Amerihealth Independence PO Box 69352 Harrisburg, PA
17106-9352
YXK (formerly QCM)
Personal Choice65
(Medicare Replacement Plan)
861
PCMA 215-241-2400
PO Box 69352 Harrisburg, PA
17106-9352 AMS,ATS,UPP,AEK,APQ,ARR ASE,AUA,AUK,BAL,BPB,BRD BWW,BYN,CBE,CDJ,CDQ,CDZ CHC,COS,CQA,CQX,CUI,CZN CZS,DAZ,DBO,DFB,DGR,DKVDPO,DVU,DWU,EEN,EGD,EIZ FFI,FQU,FSC,GCY,GEA,GEU
Blue Card & National Plans 24 NBS 215-241-2400
Independence Blue Cross PO Box 13497
Philadelphia, PA 19101
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The Alpha prefixes listed above do not constitute the entire list of Independence BC/BS prefixes. Always validate the patient’s coverage including plan type and PCP selection to ensure the appropriate FSC has been selected. BlueCard® is a national program through the Blue Cross and Blue Shield Association (BCBSA), an association of independent Blue Cross® and Blue Shield® plans, that enables enrollees of one commercial BCBSA plan to obtain health care service benefits while traveling or living in another BCBSA plan’s service area. If a patient presents with an out of state BCBS card make sure to check if it has a suitcase on it; this means we can accept the patient.
Prefix/Suffix
Plan Type
IDX-FSC
FSC
Mnemonic
Telephone
Physician
Claims Address
HAJ,HKZ,HXT,ICC,INW,IUR IYC,KPY,KXH,LFS,LLH,LMS
LRC,LYW,MGL,MNF,NPP,NZK OCR,OCZ,PAH,PBT,PDA,PSM
PTA,PUI,PXF,RAE,RID,RJG RLA,ROO,ROQ,SDA,SEZ,SFU
Blue Card & National Plans 24 NBS 215-241-2400
Independence Blue Cross PO Box 13497
Philadelphia, PA 19101
SHQ,SKH,SQT,SZA,TFE,TMB TMW,TQJ,TRX,TWS,UBF,UBLU
DS,UBL,UFN,UFP,UFT,UHF ULB,UPB,URT,WHV,WIQ,WIV
WQB
Blue Card & National Plans 24 NBS 215-241-2400
Independence Blue Cross PO Box 13497
Philadelphia, PA 19101
QCA,QCC,QCN,QCO,QCP QCR,YXN
(formerly – QCD,QCW,QCT,YXD,YXS)
Blue Card & National Plans 24 NBS 215-241-2400 Independence Blue Cross PO Box 13497
Philadelphia, PA 19101
QCE, QCR (formerly – QCS,YXS)
Security65 Medigap Plans (Secondary to Medicare)
30 P65 215-241-2400 PO Box 898845 Camp Hill, PA
17089-8845
Independence Products Prefix/Suffix IDX-FCS Table
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(MA) NEW JERSEY MEDICAL ASSISTANCE (NJMA) - MEDICAID
As of 06/01/06 Burlington, Camden and Gloucester Counties started a pilot program for the new State of New Jersey Health Benefits. Patients eligible for Medicaid who live in these counties will no longer receive the monthly paper card. They will receive a permanent plastic card displayed above. (As of 09/01/06, no paper cards will be issued.) The first three positions of the CCN or Control Number will always be “777”, followed by an eleven position non-intelligent enumeration, followed by a two-position issuance number of “01” to indicate this is the first HBID card. In the event the beneficiary requires a replacement card, the CCN will remain the same but the issuance number will increment to “02” indicating another card has been issued. A striking difference from the paper card is the lack of any eligibility and enrollment information on the card itself. There is no Medicaid ID and coverage period listed for the beneficiary; therefore, this card can not be used as proof of eligibility. Users are required to check validation tool for the Medicaid ID number and enrollment information. If the validation tool is unavailable, the user must call 800-676-6562 to verify eligibility. After verify eligibility users must enter the 10 digit Identification number and 2 digit person number a total of 12 characters within the identification number field.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
MA NEW JERSEY 101 NJMA Y MEDICAID SECONDARY 102 WAM Y
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(MA) MEDICAL ASSISTANCE (SUMMARY PAGE) - MEDICAID
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
United Healthcare Community Plan (formerly AMERICHOICE NJ HMO) 451 ACNJ Y United Healthcare Community Plan 2ndry (formerly Americhoice NJ) 207 AC2 Y
Horizon NJ Health (formerly Horizon Mercy) 96 MHP Y
Horizon NJ Health 2ndry (after Medicare) 208 MH2 Y Amerigroup 41 AMG Y Amerigroup 2ndry 44 AM2 Y
Medicaid Secondary (formerly Welfare after Medicare) 102 WAM Y
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MAGNACARE
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
MAGNACARE 189 IOE N
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MAGELLAN BEHAVIORAL HEALTH
PLAN DESCRIPTION FSC #FSC
Mnemonic EligibilityEnabled
MAGELLAN MENTAL HEALTH RowanSOM GRP #7 774 MAG N
MAGELLAN NON HMO RowanSOM GRP #7 797 MNHM N
Magellan HMO Expired RowanSOM GRP #7 778 MGE N
Magellan Non-HMO Expired RowanSOM GRP #7 796 MXP N
MAGELLAN (MENTAL HEALTH) RowanSOM GRP #4 170 GSP N
MAGELLAN NON HMO RowanSOM GRP #4 197 MNH N
Magellan HMO Expired RowanSOM GRP #4 472 MEH N
Magellan Non-HMO Expired RowanSOM GRP #4 496 MEX N
MAGELLAN MENTAL HEALTH RowanSOM GRP #3 370 MMH N
MAGELLAN NON HMO RowanSOM GRP #3 397 MNO N
Magellan HMO Expired RowanSOM GRP #3 372 MHE N
Magellan Non-HMO Expired RowanSOM GRP #3 396 MNE N
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MEDICARE/RAILROAD MEDICARE
PLAN DESCRIPTION FSC # FSC
MnemonicEligibility Enabled
Medicare Traditional 81 M Y
Medicare Travelers (Railroad) 88 MEDT Y
Medicare Traditional 2NDRY 86 MSEC Y
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MEDICARE REPLACEMENT PLANS (SUMMARY PAGE)
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
AETNA Medicare HMO 848 AEMA Y
AETNA Medicare Advantage PPO 840 AEMP Y
CIGNA HEALTHSPRING (formerly BRAVO HEALTH) * 851 BRMA Y
Horizon Medicare Advantage 874 HOMA Y
KEYSTONE 65 MEDICARE 852 KEMA Y
B/C Personal Choice 65 Medicare Replacement 861 PCMA Y
Medicare Advantage (Non Contracted) 888 MRA N
MEDICARE MCR ADVANTAGE (Non Contracted) New Selection during open enrollment period
890 MR1 N
UNIFORMED SVCS FAMILY HLTH PLN** 760 USFHP N
HORIZON NJ DIRECT MEDICARE ADVANTAGE 876 HMAP Y
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MULTIPLAN
Please add logo:
Multiplan (TPA) Third Party Administrator (TPA): Third Party Administrators serve as PPO Networks. TPAs provide administrative services to small employer groups and/or self funded Health Organizations; they re-price the claims to ensure the best payment rate. Benefit limitations may apply.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
MULTI PLAN 43 ETH N
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OXFORD
PREFERRED HEALTH NETWORK
PLAN DESCRIPTION FSC # FSC Mnemonic Eligibility Enabled
OXFORD 151 OHP Y
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(MAX)
*Needs to be Deactivate
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
PREFERRED HEALTH NETWORK (MAXNET) 78* MAX N
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QUALCARE
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
QualCare 350 QC N
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THIRD PARTY ADMINISTRATORS (TPA)
TPA Listings Third Party Administrator (TPA): Third Party Administrators serve as PPO Networks. TPAs provide administrative services to small employer groups and/or self funded Health Organizations; they re-price the claims to ensure the best payment rate. Benefit limitations may apply.
PLAN DESCRIPTION FSC # FSC Mnemonic Eligibility Enabled
AETNA TPA (Aetna Signature Administrators) 462 ATPA N Devon 165 AMRC N Intergroup 454 ITG N Preferred Health Network (MAXNET) 78 MAX N Multiplan 43 ETH N MagnaCare PPO 189 MAGP N
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CHAMPUS (TRICARE)
TRICARE Prime participation through US Family Health Plan. All other TRICARE Products are non-par but may have out of network benefits.
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
CHAMPUS/HEALTHNET 47 CHA Y
Tricare For Life (Secondary To Medicare) 50 CIM Y
CHAMPVA 41 CI N
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UNION INSURANCE (LOCAL UNIONS)
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
COMMERCIAL-Primary 41 CI N
COMM INSUR-2NDRY 44 CIS N
COM INS AFT MEDICARE 50 CIM N
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UNITED BEHAVIORAL HEALTH
NON-PAR Plan
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
UNITED BEHAVIORAL HEALTH-for Group 3 398 MENT N
UNITED BEHAVIORAL HEALTH-for Group 4 198 MENH N
UNITED BEHAVIORAL HEALTH-for Group 7 798 MHLT N
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UNITED HEALTHCARE/GOLDEN RULE
PLAN DESCRIPTION FSC # FSC
Mnemonic EligibilityEnabled
UNITED HEALTHCARE HMO 76 MLN Y
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UNITED HEALTHCARE GROUP - (SUMMARY PAGE)
. . AARP Certified users will continue registering patients presenting with Medicare primary and have AARP as secondary insurance coverage in the IDX-FSC listed above. AARP Healthcare Options offers primary personal health insurance plans to qualifying individuals. Individuals between the ages of 50 to 64 have several plans available from which to choose. Please note that these plan benefits include large out-of-pocket expenses and limitations. Patients presenting for services with this product should be registered as described above. .
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
UNITED HEALTHCARE - HMO 76 MLN Y UNITED HEALTHCARE COMMUNTY PLAN (formerly Americhoice of NJ) 451 ACNJ
Y
UNITED HEALTHCARE COMMUNITY PLAN 2NDRY (formerly Americhoice of NJ)
207 AC2 Y
ONENET PPO (formerly Alliance PPO) 41 CI N
OXFORD 151 OHP Y
AARP (Secondary to Medicare) Medigap 50 CIM Y
AARP (Primary Commercial Plans) 41 CI Y
UNITED BEHAVIORAL HEALTH-for Group 3 398 MENT N
UNITED BEHAVIORAL HEALTH-for Group 4 198 MENH N
UNITED BEHAVIORAL HEALTH-for Group 7 798 MHLT N
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US FAMILY HEALTH PLAN
TRICARE PRIME
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
UNIFORMED SVCS FAMILY HLTH PLN 760 USFHP N
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VALUE OPTIONS BEHAVIORAL HEALTH
RowanSOM has entered into an agreement with Value Options Behavioral Health services comprising Horizon Blue Cross Blue Shield (BC/BS) family of plans including Horizon NJ Health Medicaid. Value Options will replace Magellan Health Services for the Horizon Blue Cross Blue Shield (BC/BS) family of plans. Individuals enrolled with Horizon NJ Health plan, behavioral health benefits will include Developmental Disabilities, and Managed Long Term Services & Support (MLTSS) only under Value Options. Individuals with the Horizon NJ Health plan receiving behavioral health services coinciding with routine outpatient services, urgent/emergent and/or acute medical admissions should be billed to NJ Medical Assistance (NJMA). Patient present for service on or after July 1, 2014 should be registered as described above. Claims Submission Address Horizon Value Options Horizon Behavioral Health PO Box 10191 Newark, NJ 07101‐3189 Payer ID No. 22099
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
Value Options HMO GRP#3 340 VAH N
Value Options Non-HMO GRP#3 399 VAL N
Value Options HMO GRP#4 440 VOH N
Value Options Non-HMO GRP#4 499 VLU N
Value Options HMO GRP#7 740 VOL N
Value Options Non-HMO GRP#7 799 VLO N
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VETERANS ADMINISTRATION
PLAN DESCRIPTION FSC # FSC
Mnemonic Eligibility Enabled
COMMERCIAL-Primary 41 CI N
COMM INSUR-2NDRY 44 CIS N
COM INS AFT MEDICARE 50 CIM N
To ensure RowanSOM receives payment for Veteran patients presenting for services, the following are required:
Pre-Authorization prior to rendering any medical services (7078 letter).