Member ID Prefix Information - AZBlue

1 Member ID Prefix Information An important element of the Member ID number is the Prefix , which typically has three alpha characters. The Prefix is required to identify the Member 's Home plan and access eligibility and benefit Information . The Prefix is also used to direct claims to the appropriate areas for processing. Providers are required to use the correct Prefix on claims and correspondence. Use all alpha characters and numbers as shown on the ID card when submitting claims. Sample of Member ID Prefix (and other important ID card Information ): LOGO: Plan Service Area Is it BCBSAZ? An Independent Licensee of the Prefix Blue Cross and Blue Shield Association (Part of Member ID). Use to access eligibility Member Name: Group No: EH002. and benefit info JOHN DOE Dependent(s) Name: Check to see if plan JANE.

2 Was purchased on/off RAYMOND. the Exchange Member ID: LUCY CARD PRINT DATE. Is the card current XBG123456789 Card Print Date: 11/6/13 (within 1-2 years)? NETWORK NAME. Examples: In-Network Cost Share: Rx BIN #: 603017. PPO Network: PPO Rx Copay: Select Deductible: $1000 Level 1/Level 2: $15/$40. Alliance Coinsurance: 80% Level 3: $80. Secure (as of 2015) PCP/Specialist Copay: $25/$40 Vision Exam Copay: $20. Acclaim UC Copay/ER Access Fee $60/$250 Chiropractic Copay: $40. Are you a provider? SUITCASE LOGO. EverydayHealth indicates out-of-area coverage Information PRODUCT NAME. More about BCBSAZ Prefixes Most prefixes assigned to BCBSAZ medical plans begin with XB plus a third letter, which identifies the product. Dental plans use the 99D Prefix . The Federal Employee Program Prefix is R. Certain large groups may have unique alpha prefixes.

3 Standard prefixes that may appear on Member ID cards issued by BCBSAZ are: Network Type Availability Standard Prefix Off Exchange XBB, XBG, XBM, XBP, XBX, XBY. Statewide PPO. On Exchange XBE, XBF. Off Exchange XBN, XBT. Exclusive network: Alliance On Exchange XBA. Off Exchange XBJ. Exclusive network: Select On Exchange XBI. Exclusive network: Acclaim (for large, self-funded groups only) Off Exchange XBR. Indemnity Off Exchange XBC, XBD. HMO Off Exchange XBH, XBK, XBO, XBQ, XBV. Senior Preferred/Medicare Supplement Off Exchange XBS. Medicare Advantage Off Exchange XBU. Dental Only Plan or BluePreferred Dental Off Exchange 99D (replaces XBW as of 9/1/14). FEP Off Exchange R. NOTES: Off Exchange indicates product is sold off the Health Insurance Marketplace Exchange. On Exchange indicates product is sold on the Health Insurance Marketplace Exchange, indicated by a different Prefix .

4 Exclusive networks: Check ID card for the specific network name and related Prefix , as these benefit plans use a narrow provider network. Exclusive network members may have significant out-of-pocket expenses when going outside their network. Rev. September 16, 2014 . Unique Alpha Prefix List for Certain Large Groups BCBSAZ assigns unique group-specific prefixes to certain large (1000+) groups with a PPO benefit plan. members of these groups have a unique 3-character alpha Prefix that does not start with XB as part of their BCBSAZ Member ID. number. For large accounts with multiple health plan options, HMO and PPO, only the members with PPO. coverage will have ID cards issued with the group-specific prefixes. members with HMO coverage will have one of the standard HMO prefixes listed above.

5 The following is the current list (as of 9-16-14) of group-specific prefixes: Group Name Unique Alpha Prefix Effective Date Abeinsa EPC, LLC ABD May 1, 2014 . Apogee Medical Management APK March 1, 2014 . Apollo Education Group APZ January 1, 2015. Banner Health BNE January 1, 2014 . BCBS of Arizona EWX January 1, 2010. City of Chandler CTZ January 1, 2011. City of Glendale (EPO/PPO) CGF July 1, 2014 . City of Mesa MDK January 1, 2012. City of Peoria NBE January 1, 2010. City of Peoria (EPO) COV July 1, 2010. City of Phoenix (PPO plan only) PXO August 1, 2009. Empire Southwest EJY December 1, 2010. Gila River Gaming Enterprises, Inc. GLK January 1, 2014 . Glendale Union High School District GHU July 1, 2009. ISOLA USA Corp. IOA June 1, 2011. Kingman Regional Hospital KGM July 1, 2014 . Kitchell Corporation CDC November 1, 2011.

6 Knight Transportation KTO January 1, 2013. Limelight Networks, Inc. LNT January 1, 2014 . Midwestern University MUM January 1, 2014 . Northern Arizona Healthcare NHY January 1, 2010. Northern Arizona Public Employees Benefit Trust NZI July 1, 2009. Northern Arizona University NOR January 1, 2011. Phoenix Childrens Hospital PXD Jan. 1, 2013. Phoenix Elementary School District PUO July 1, 2011. Phoenix Union High School District No. 210 PUS July 1, 2009. Pima County Community College District PCL July 1, 2014 . Schuff Steel International HYF September 1, 2009. Semiconductor Components Industries, Inc. OSE January 1, 2009. Snell & Wilmer, LLP SWB January 1, 2014 . Sprouts Farmers Markets, LLC FSJ August 1, 2009. State of Arizona SYD January 1, 2015. Sunstate Equipment WSE January 1, 2014 . Sumco Phoenix Corporation SPH June 1, 2013.

7 Super Shuttle SSO May 1, 2011. Swift Transportation SWT January 1, 2015. Tempe Elementary School District TMZ July 1, 2010. Tohono O'odham Nation ODM October 1, 2011. Truly Nolen of America, Inc. TTK January 1, 2014 . Rev. September 16, 2014 . Group Name Unique Alpha Prefix Effective Date U-Haul International, Inc. UHL January 1, 2009. UNS Energy Corporation UNS January 1, 2015. Yuma County UYU January 1, 2012. Rev. September 16, 2014 .