Before treating our members, ask to see their member ID card, along with their photo ID. Our member ID cards have important information for billing and determining benefits, including the member ID number and group number.
Include the three-character prefix: Most members have a three-character prefix at the beginning of their unique ID number. When recording the member’s ID number, include the three-character prefix. The alpha prefix is used to:
- Confirm the member’s eligibility and coverage information
- Identify and correctly route claims to the appropriate Blue Cross and Blue Shield Plan for processing
There are two types of prefixes:
- Plan-specific prefixes: These are assigned to every Blue Cross and Blue Shield Plan and start with X, Y or Q:
- The first two positions indicate the Plan to which the member or subscriber belongs
- The third position identifies the product in which the member or subscriber is enrolled
- Account-specific prefixes: These are assigned to national accounts, which are employer groups that may have offices across multiple states and offer uniform coverage benefits to their employees. The prefix assigned to the national account is tied to the employer’s name.
Identify the member’s network: The three-character network value appears in on ID cards where network benefits may apply. Check for:
- PPO − Blue Choice PPOSM
- EPP – Blue Preferred PPOSM
- BVP – Blue Advantage PPOSM
- HMO – BlueLincs HMOSM
- BAV – MyBlue HMOSM
- NTV – NativeBlueSM PPO
Verify patient eligibility and benefits before every scheduled appointment. Use Availity® Essentials or your preferred vendor to check eligibility and benefits before rendering services. This step will also help you determine if services require prior authorization
If you have questions, call the number on the member’s ID card.
Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Oklahoma. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.