Members

Popular Member Searches — Arkansas Blue Cross Members


Filing a Claim

Most doctors or hospitals will file your claim for you. Discuss filing arrangements with your health care provider. Be sure the health care provider has your most current insurance information. Showing a copy of your ID card, while not a guarantee of benefits, will assist the health care provider in completing the claim form properly. The Schedule of Benefits mailed to you with your ID card has helpful general information. You can file a claim when a health care provider is not filing the claim for you. Links to forms are provided below or contact your local Arkansas Blue Cross 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 health care provider's invoice or stationary and attached to the claim form. A separate form must be submitted for each patient.

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Pregnancy Costs

Coinsurance — 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. All financial arrangements are made between the health care providers and insured, so please discuss this with your doctor and hospital. They will want to help you.

Deductible — Deductibles are applied on a calendar-year basis and will be applied on eligible services (including maternity care and delivery) until the deductible has been met.

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Requesting 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. Please 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, please call the Customer Service number that appears on your ID card.

If You Have Other Coverage

If you have additional health insurance 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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Family Members Request for Policyholder Information

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 (PDF).

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Canceling or Suspending Your Medi-Pak Policy

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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Prior Approval - Gastric Bypass and Organ Transplants

Gastric Bypass and Organ Transplants
Gastric bypass procedures and organ transplants (except for cornea or 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, please have your health care 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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Precertification vs. Pre-notification

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. Arkansas Blue Cross 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. If you are an FEP or BlueAdvantage Administrators of Arkansas member, 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. All other members should contact Customer Service.

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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. National Imaging Associates (NIA) and New Directions based on medical guidelines from Arkansas Blue Cross conduct the review. 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, MRIs, CTs, 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) —

  • Inpatient stays
  • Emergency admission (next business day)
  • Partial hospitalization program
  • Intensive outpatient program
  • Prior to ninth outpatient visit

For any assistance, call the Customer Service number that appears on your ID card.

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