Payer ID provider number reference — Facility
Rev. April 20231Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East, and QCC Insurance Company independent licensees of the Blue Cross and Blue Shield ID provider number reference FacilityUse this guide as a reference tool when submitting Facility claims. The information was current at the time of publication. We will announce changes on the provider News Center and the provider Engagement, Analytics & Reparting (PEAR) portal. PrefixProduct namePayer information for electronic claimsPaper claim mailing addressBilling providerISA-08GS-03Keystone Health Plan EastIndependenceQCGKeystone Health Plan East POS5470495056Claims Receipt Box 211184Eagan, MN 55121Valid and registered NPI is (837I)Loop 2010AANM108 = XXNM109 = NPI # paper (UB-04)NPI # Box 56QCHKeystone Health Plan East HMOQCIKeystone 65 HMOKeystone 65 Focus Rx HMOQCJKeystone Health Plan East ERISA POSQCKKeystone 65 POSQCLKeystone Health Plan East ERISA HMOQHXIBC HMO Proactive Individual Off ExchangeQSPIBC HMO Proactive Small GroupQXJIBC HMO Proactive Individual On ExchangeYXQKeystone HMO Platinum On Exchange*Keystone HMO Gold On ExchangeKeystone HMO Silver Classic On ExchangeKeystone HMO Silver Basic On ExchangeKeystone HMO Bronze On ExchangeKeystone HMO Gold Classic On ExchangeYXRSmall Group POS On Exchange*YXWKeystone HMO Platinum Off Exchange*Keystone HMO Gold Off Excha
Paper claim mailing address Billing provider ISA-08 GS-03 Keystone Health Plan East Independence QCG Keystone Health Plan East POS 54704 95056 12X25 Claims Receipt Center P.O. Box 211184 Eagan, MN 55121 Valid and registered NPI is required. Electronic (837I) Loop 2010AA NM108 = XX NM109 = NPI # Paper (UB-04) NPI– # – Box 56
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