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Frequently Asked Questions — Members:
Arkansas Blue Cross and Blue Shield Plans
General
- How do I file a claim?
- How do I mail a claim?
- How long does it take to process a claim?
- After a claim is processed, who receives the payment?
- How do I request an appeal?
- If I think an error has been made on my claim, how do I ask for a review?
- Who do I contact with questions about claim status or benefits?
- Who do I contact with questions about the Explanation of Benefits (EOB)?
- Why do you want to know if I have other coverage?
- How do I mail a premium?
- Is there a grace period on the billing?
- What are my billing and payment options?
- I received my monthly premium statement. Why was my last month's premium payment not posted?
- Why didn't I get my premium statement this month?
- Can any of my family members obtain information on my policy?
- Should I cancel or suspend my Medi-Pak policy now that I have Medicaid?
- What information is available on the Web site?
Medical Benefits
- Do you cover gastric bypass or organ transplant?
- What is the difference between precertification and pre-notification? When is it needed?
- What requires prior authorization?
- If I go to the emergency room and they admit me, do I have to pay the copayment?
- What is BlueCard®?
Group Maternity
- My husband’s employer is changing insurance plans next month,
and I am 4 months pregnant. Will my pregnancy be covered under his new plan?
- My doctor wants me to have an ultrasound. Is this covered?
- My doctor and the hospital want me to pay my coinsurance portion
before I have the baby. How much will I be responsible for?
- If my pregnancy goes into a new calendar year, will I have
to pay two deductibles to my doctor?
- Does Arkansas Blue Cross and Blue Shield cover midwife
services?
- What services are covered under my maternity benefits?
- Does Arkansas Blue Cross and Blue Shield cover epidurals?
For any other questions, please call the Customer Service number found on the back of your ID card.
General
1. How do I file a claim?
Most providers will file your claim for you. Discuss filing arrangements with the provider. Be sure the provider has your
most current insurance information. Showing the provider a copy of your ID card, while not a guarantee of benefits, will
assist the provider in completing the claim form properly. The Schedule of Benefits mailed to you with your ID card has
helpful general information that may benefit providers. You can file a claim when a provider is not filing the claim
for you. Links to forms are provided below or contact your local Arkansas Blue Cross and Blue Shield office for a Claim
Form or call the number on the back of your ID Card. Instructions for filing are on the back of the claim form. All bills
should be itemized, submitted on the provider's invoice or stationary and attached to the Claim Form. A separate form must
be submitted for each patient.
- Prescription Claim Form (882 KB PDF) This claim form should not be used by CHIP policyholders. Prescription drug claims for CHIP policyholders should be filed using the Medical Claim Form linked above.
All other claim forms: Forms for Members
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2. How do I mail a claim?
Mail a completed Claim Form, along with the attached itemized bills, to:
Arkansas Blue Cross and Blue Shield
P O Box 2181
Little Rock AR 72203-2181
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3. How long does it take to process a claim?
If the claim does not require any additional requests for information or review it can take 3-5 days
for processing. A claim can take longer depending on the requested information. For any assistance,
call the customer service number that appears on your ID card.
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4. After a claim is processed, who receives the payment?
If the provider agrees to accept Arkansas Blue Cross and Blue Shield fee schedule allowances, this usually
means the provider will not balance bill and Arkansas Blue Cross will make payment directly to the provider. Arkansas
Blue Cross payment for claims involving providers who do not accept Arkansas Blue Cross and Blue Shield fee schedule
allowances is sent to the policyholder and not the provider.
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5. How do I request an appeal?
If a claim for payment is denied, the member must ask for an appeal in writing
within 180 days after notification of the denial of benefits. Send your request
to:
Appeals Coordinator of Arkansas Blue Cross and Blue Shield
P.O. Box 2181
Little Rock AR 72203-2181
Appeal Fax: 501-378-3366
Submit issues and comments as well as any additional information relevant to your claim with your request for appeal. A
complete review will be made of all information. You will receive a final decision in writing within 60 days after your
request is received unless special circumstances require extensive review. For any assistance, call the customer service
number that appears on your ID card.
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6. If I think an error has been made on my claim,
how do I ask for a review?
After you receive the Explanation of Benefits (EOB), if you need clarification of the action taken, you should write,
e-mail or call Customer Service. For any assistance, call the customer service number that appears on your ID card. Provide
your ID number and refer to the claim number (Claim #) indicated on the upper portion of the EOB. Having the information
in hand will save time when you call.
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7. Who do I contact with questions about claim status or benefits?
For assistance, call the customer service number that appears on your ID card or e-mail Customer Service
at customerserviceABCBS@arkbluecross.com. If you would like to receive 24/7 access to your benefits, pharmacy and
medical claims and much more, register with My Blueprint.
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8. Who do I contact with questions about the Explanation of Benefits (EOB)?
For assistance with claim inquiries, consult your ID card for the customer service telephone number. You can also
e-mail customer service or submit your questions in writing to:
Arkansas Blue Cross and Blue Shield
P.O. Box 2181
Little Rock, AR 72203-2181
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9. Why do you want to know if I have other
coverage?
A decision must be made as to which coverage is responsible for primary payment. Please complete the coordination of benefits questionnaire or
call the customer service number that appears on your ID card.
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10. How do I mail a premium?
Mail the attached invoice, along with the check in the amount due, to:
Arkansas Blue Cross and Blue Shield
P.O. Box 3590
Little Rock, AR 72203
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11. Is there a grace period on the billing?
There is a 30-day grace period on the billing from the due date.
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12. What are my billing and payment options?
Billing Options:
1. Monthly draft
2. Quarterly
3. Semi- Annual
4. Annual
Payment Options:
1. Monthly draft
2. Mail check or money order
3. Check-by-phone
4. My Blueprint online payment
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13. I received my monthly premium statement. Why was my
last month's premium payment not posted?
Your last month's premium payment was likely received and posted after the statements were printed. For
assistance, call the customer service number that appears on your ID card.
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14. Why didn't I get my premium statement this month?
Many factors could have occurred. However, if you have not received your statement by the end of the month, to
avoid cancellation you can call Customer Service at the number noted on the back of your member ID card to pay
by phone with a customer service representative or register with My Blueprint to pay online.
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15. Can any of my family members obtain information on my policy?
No, if the family member is not on the policy, information cannot be obtained. If you would like someone else to
obtain information on your policy or speak on your behalf, you can complete an Authorization for Release Form (5 KB PDF)
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16. Should I cancel or suspend my Medi-Pak policy now that I have Medicaid?
Since you have Medicaid, you no longer need Medi-Pak because Medicaid covers what Medi-Pak covers. You have the option of suspending
your Medi-Pak policy for 24 months if certain criteria are met. You have up to 90 days from the date of notification of
Medicaid eligibility to contact Arkansas Blue Cross requesting to suspend your Medi-Pak policy. You must also put this
request in writing including your policy number, your signature and the date you sign the request.
Fax the request:
ATT: QMB Suspensions
501-378-2058
Mail the request:
Arkansas Blue Cross and Blue Shield
ATT: QMB Suspensions
P.O. Box 2181
Little Rock, AR 72203
If 90 days has passed since you were notified of Medicaid eligibility your only option is to cancel the policy in writing
or by non-payment of premium.
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17. What information is available on the Web site?
Here are a few topics found on the Web site. More information and forms are available.
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My Blueprint allows members to check
eligibility, check status of medical claims, review claims history, see personal health record, access health information,
order ID cards and manage other health-plan services.
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Provider Directory allows members to
find a doctor, hospital or health-care facility or other services such as home care and medical equipment.
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Health Care Education offers disease-specific medical information and education free of charge to our members.
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Member Discounts Arkansas Blue Cross and Blue Shield negotiates discounts for members for health- related services.
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Coverage Policy The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health plans.
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Medical Benefits
1. Do you cover gastric bypass or organ transplant?
Gastric bypass and organ transplant except for cornea kidney transplant procedures require prior approval. Prior Approval is a request from a physician for the approval of a proposed hospitalization, a surgical procedure, or a medical treatment. To obtain prior approval,
send have your provider send a written request to:
Arkansas Blue Cross and Blue Shield
Attn: Medical Audit and Review
P.O. Box 2181
Little Rock, AR 72203-2181
Fax: 501-378-6647
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2. What is the difference between precertification and pre-notification? When is it needed?
Consult your benefit booklet or contact the customer service number on your ID card to determine if you are subject to precertification
or pre-notification prior to certain medical services.
Preadmission certification or precertification is a process where a member must call and receive prior approval for an
admission into any hospital. Failure to receive preadmission certification usually involves a penalty payment by the
member of a specified dollar amount – varies by plan design. Arkansas Blue Cross and Blue Shield no longer requires
preadmission certification.
Pre-notification is a process where a member should call in prior to admission to an out-of-network hospital facility or a
hospital outside the state of Arkansas to alert us of the admission. Pre-notification provides information helping to
determine if case management would be an appropriate option for the member.
Pre-notification is not required for outpatient treatment or any in-state, in-network inpatient admissions.
If your inpatient admission does not fall within the described exceptions previously mentioned, your policy may require
pre-notification. You, your admitting physician, or the hospital would need to contact Integrated Health, the Arkansas
Blue Cross and Blue Shield pre-notification vendor, by calling 1-800-451-7302.
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3. What requires prior authorization?
Prior authorization is a review prior to the time a specified procedure is scheduled. This review consists of checking
clinical documentation to verify the medical necessity for the procedure. The review is done by National Imaging
Associates (NIA) and New Directions based on medical guidelines from Arkansas Blue Cross and Blue Shield. A prior
authorization is required for each different procedure, even if those procedures are performed on the same day. Failure
to obtain prior authorization will result in denial of the claim.
Procedures requiring prior authorization:
NIA — Specified high tech radiology procedures, MRI's, CT's, PET scans, and nuclear cardiology, must have prior
authorization. Inpatient services, emergency room services and observation room services are not subject to this review.
New Directions (Still applies if insurance is secondary payor) —
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Inpatient stays
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Emergency admission (next business day)
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Partial hospitalization program
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Intensive outpatient program
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Prior to 9th outpatient visit
For any assistance, call the customer service number that appears on your ID card.
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4. If I go to the emergency room and they admit me, do I have to pay the copayment?
No, if you are admitted to the hospital within 23 hours for observation or to the hospital.
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5. What is BlueCard®?
BlueCard is a national program that enables
access (with discounts) to the participating providers of various Blue Cross and Blue Shield plans. Contact your
employer or call the customer service number on your ID card to determine if you participate in this program.
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Group Maternity
1. My husband’s employer is changing insurance plans
next month, and I am 4 months pregnant. Will my pregnancy be covered under his
new plan?
Yes. Pregnancy does not fall under the pre-existing condition limitations of a
group health insurance plan that has maternity coverage. Your pregnancy will be
covered from the first day of your husband’s new plan with Arkansas Blue Cross
and Blue Shield. Any charges before you became effective with Arkansas Blue
Cross and Blue Shield would not be covered.
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2. My doctor wants me to have an ultrasound. Is this
covered?
We cover ultrasounds if they are medically necessary. This means there must be a
specific medical reason for this test. We also cover one routine ultrasound,
such as those to check the sex of the baby. Additional routine ultrasounds are
not covered.
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3. My doctor and the hospital want me to pay my
coinsurance portion before I have the baby. How much will I be responsible for?
All charges will be subject to your yearly deductible and coinsurance. Both the
doctor and hospital will prepare an estimate and ask you to pay a specified
amount, based on that estimate. We are not involved in that process, and all
financial arrangements are made between the healthcare providers and insured.
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4. If my pregnancy goes into a new calendar year,
will I have to pay two deductibles to my doctor?
No. Your doctor will not file a claim until after you have delivered the baby.
We will just apply one deductible to your maternity claims.
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5. Does Arkansas Blue Cross and Blue Shield cover
midwife services?
Yes, coverage is provided through the employing physician for services provided
by a certified nurse midwife employed by a physician.
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6. What services are covered under my maternity
benefits?
Physician visits and all necessary lab work are covered under your maternity
benefits.
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7. Does Arkansas Blue Cross and Blue Shield cover
epidurals?
Yes, we do cover epidurals.
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