BCBS insurance id starts with VMB, VMA, XJQ, XJX and VME

How will our office recognize an Exchange member?

Our member identification (ID) cards will not change. However, there will be new alpha prefixes on ID cards for Exchange members:

VMB = Individual HMO
VMA = Individual PPO
XJQ = Small Group HMO
XJX = Small Group
VME/VMD = Individual HMO and PPO off-Exchange

How do I verify member benefits?

You may verify eligibility and benefits for Florida Blue members on the Exchange as you do today for any other Florida Blue member. Providers and/or their designees (billing services, clearinghouses, etc.) should use clinical, financial and administrative electronic self-service capabilities including those accessed through Availity®1. These capabilities include but are not limited to:

• Submitting administrative inquiries electronically through Availity using Authorizations and Referrals Review and Inquiry, Eligibility and Benefits, CareCalc®, the Claim Reconciliation Tool and Claims Status.

• When using certain Availity transactions (Authorizations and Referrals Review and Inquiry, Eligibility and Benefits Inquiry), providers should use the automated transaction capability and obtain a transaction ID through Availity. Providers will not receive eligibility and benefits information from Florida Blue without a transaction ID. This transaction ID will also provide fast-path priority service if you should need to call the Florida Blue Provider Contact Center for assistance. You may call the Provider Contact Center at (800) 727-2227.

What if a member does not have an ID card or I can’t find eligibility and benefits information in Availity?

If you cannot find member information in Availity, call the Provider Contact Center at (800) 727-2227 for enrollment status or have the member call the number on the back of their ID card. As a reminder, if the member does not have an ID card and does not know their member ID number, you can check eligibility and benefits in Availity by using the member’s name and date of birth.

Will providers who already use electronic transactions have to do anything differently?

No. Providers should continue to follow the same processes in place today.

What is the coverage effective date for members enrolled on the Exchange?

For members who enroll on the Exchange between Oct.1, 2013 – Dec. 23, 2013, the coverage effective date is Jan. 1, 2014.

Exchange open enrollment continues from Dec. 23, 2013 – Mar. 31, 2014.  Applications received prior to the 15th day of the month are effective the first day of the following month. For example, if an application is received on Mar. 10, 2014, the coverage effective date is Apr. 1, 2014.  

Medicare HIC Prefixes and Suffixe code and explanation

Medicare HIC Prefixes and Suffixes

HIC Suffix      Sex      Explanation

A     M or F     PRIMARY CLAIMANT

B     F     AGED WIFE, AGE 62 OR OVER (FIRST CLAIMANT)

B1     M     AGED HUSBAND, AGE 62 OR OVER (FIRST CLAIMANT)

B2     F     YOUNG WIFE, WITH A CHILD IN HER CARE (FIRST CLAIMANT)

B3     F     AGED WIFE (SECOND CLAIMANT)

B4     M     AGED HUSBAND (SECOND CLAIMANT)

B5     F     YOUNG WIFE (SECOND CLAIMANT)

B6     F     DIVORCED WIFE, AGE 62 OR OVER (FIRST CLAIMANT)

B7     F     YOUNG WIFE (THIRD CLAIMANT)

B8     F     AGED WIFE (THIRD CLAIMANT)

B9     F     DIVORCED WIFE (SECOND CLAIMANT)

BA     F     AGED WIFE (FOURTH CLAIMANT)

BD     F     AGED WIFE (FIFTH CLAIMANT)

BG     M     AGED HUSBAND (THIRD CLAIMANT)

BH     M     AGED HUSBAND (FOURTH CLAIMANT)

BJ     M     AGED HUSBAND (FIFTH CLAIMANT)

BK     F     YOUNG WIFE (FOURTH CLAIMANT)

BL     F     YOUNG WIFE (FIFTH CLAIMANT)

BN     F     DIVORCED WIFE (THIRD CLAIMANT)

BP     F     DIVORCED WIFE (FOURTH CLAIMANT)

BQ     F     DIVORCED WIFE (FIFTH CLAIMANT)

BR     M     DIVORCED HUSBAND (FIRST CLAIMANT)

BT     M     DIVORCED HUSBAND (SECOND CLAIMANT)

BW     M     YOUNG HUSBAND (SECOND CLAIMANT)

BY     M     YOUNG HUSBAND (FIRST CLAIMANT)

C1-C9, CA-CZ     M or F     CHILD (INCLUDES MINOR, STUDENT OR DISABLED CHILD)

D     F     AGED WIDOW, 60 OR OVER (FIRST CLAIMANT)

D1     M     AGED WIDOWER, AGE 60 OR OVER (FIRST CLAIMANT)

D2     F     AGED WIDOW (SECOND CLAIMANT)

D3     M     AGED WIDOWER (SECOND CLAIMANT)

D4     F     WIDOW (REMARRIED AFTER ATTAINMENT OF AGE 60) (FIRST CLAIMANT)

D5     M     WIDOWER (REMARRIED AFTER ATTAINMENT OF AGE 60) (FIRST CLAIMANT)

D6     F     SURVIVING DIVORCED WIFE, AGE 60 OR OVER (FIRST CLAIMANT)

D7     F     SURVIVING DIVORCED WIFE (SECOND CLAIMANT)

D8     F     AGED WIDOW (THIRD CLAIMANT)

D9     F     REMARRIED WIDOW (SECOND CLAIMANT)

DA     F     REMARRIED WIDOW (THIRD CLAIMANT)

DC     M     SURVIVING DIVORCED HUSBAND (FIRST CLAIMANT)

DD     F     AGED WIDOW (FOURTH CLAIMANT)

DG     F     AGED WIDOW (FIFTH CLAIMANT)

DH     M     AGED WIDOWER (THIRD CLAIMANT)

DJ     M     AGED WIDOWER (FOURTH CLAIMANT)

DK     M     AGED WIDOWER (FIFTH CLAIMANT)

DL     F     REMARRIED WIDOW (FOURTH CLAIMANT)

DM     M     SURVIVING DIVORCED HUSBAND (SECOND CLAIMANT)

DN     F     REMARRIED WIDOW (FIFTH CLAIMANT)

DP     M     REMARRIED WIDOWER (SECOND CLAIMANT)

DQ     M     REMARRIED WIDOWER (THIRD CLAIMANT)

DR     M     REMARRIED WIDOWER (FOURTH CLAIMANT)

DS     M     SURVIVING DIVORCED HUSBAND (THIRD CLAIMANT)

DT     M     REMARRIED WIDOWER (FIFTH CLAIMANT)

DV     F     SURVIVING DIVORCED WIFE (THIRD CLAIMANT)

DW     F     SURVIVING DIVORCED WIFE (FOURTH CLAIMANT)

DX     M     SURVIVING DIVORCED HUSBAND (FOURTH CLAIMANT)

DY     F     SURVIVING DIVORCED WIFE (FIFTH CLAIMANT)

DZ     M     SURVIVING DIVORCED HUSBAND (FIFTH CLAIMANT)

E     F     MOTHER (WIDOW) (FIRST CLAIMANT)

E1     F     SURVIVING DIVORCED MOTHER (FIRST CLAIMANT)

E2     F     MOTHER (WIDOW) (SECOND CLAIMANT)

E3     F     SURVIVING DIVORCED MOTHER (SECOND CLAIMANT)

E4     M     FATHER (WIDOWER) (FIRST CLAIMANT)

E5     M     SURVIVING DIVORCED FATHER (WIDOWER) (FIRST CLAIMANT)

E6     M     FATHER (WIDOWER) (SECOND CLAIMANT)

E7     F     MOTHER (WIDOW) (THIRD CLAIMANT)

E8     F     MOTHER (WIDOW) (FOURTH CLAIMANT)

E9     M     SURVIVING DIVORCED FATHER (WIDOWER) (SECOND CLAIMANT)

EA     F     MOTHER (WIDOW) (FIFTH CLAIMANT)

EB     F     SURVIVING DIVORCED MOTHER (THIRD CLAIMANT)

EC     F     SURVIVING DIVORCED MOTHER (FOURTH CLAIMANT)

ED     F     SURVIVING DIVORCED MOTHER (FIFTH CLAIMANT

EF     M     FATHER (WIDOWER) (THIRD CLAIMANT)

EG     M     FATHER (WIDOWER) (FOURTH CLAIMANT)

EH     M     FATHER (WIDOWER) (FIFTH CLAIMANT)

EJ     M     SURVIVING DIVORCED FATHER (THIRD CLAIMANT)

EK     M     SURVIVING DIVORCED FATHER (FOURTH CLAIMANT)

EM     M     SURVIVING DIVORCED FATHER (FIFTH CLAIMANT)

F1     M     FATHER

F2     F     MOTHER

F3     M     STEPFATHER

F4     F     STEPMOTHER

F5     M     ADOPTING FATHER

F6     F     ADOPTING MOTHER

F7     M     SECOND ALLEGED FATHER

F8     F     SECOND ALLEGED MOTHER

J1     M or F     PRIMARY PROUTY ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND)

J2     M or F     PRIMARY PROUTY ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND)

J3     M or F     PRIMARY PROUTY NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND)

J4     M or F     PRIMARY PROUTY NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND)

K1     F     PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (FIRST CLAIMANT)

K2     F     PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (FIRST CLAIMANT)

K3     F     PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (FIRST CLAIMANT)

K4     F     PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (FIRST CLAIMANT)

K5     F     PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (SECOND CLAIMANT)

K6     F     PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (SECOND CLAIMANT)

K7     F     PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (SECOND CLAIMANT)

K8     F     PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (SECOND CLAIMANT)

K9     F     PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (THIRD CLAIMANT)

KA     F     PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (THIRD CLAIMANT)

KB     F     PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (THIRD CLAIMANT)

KC     F     PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (RSI TRUST FUND) (THIRD CLAIMANT)

KD     F     PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.) (GENERAL FUND) (FOURTH CLAIMANT)

KE     F     PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C (FOURTH CLAIMANT)

KF     F     PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(FOURTH CLAIMANT)

KG     F     PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.)(FOURTH CLAIMANT)

KH     F     PROUTY WIFE ENTITLED TO HIB (LESS THAN 3 Q.C.)(FIFTH CLAIMANT)

KJ     F     PROUTY WIFE ENTITLED TO HIB (OVER 2 Q.C.) (FIFTH CLAIMANT)

KL     F     PROUTY WIFE NOT ENTITLED TO HIB (LESS THAN 3 Q.C.)(FIFTH CLAIMANT)

KM     F     PROUTY WIFE NOT ENTITLED TO HIB (OVER 2 Q.C.) (FIFTH CLAIMANT)

T     M or F     UNINSURED-ENTITLED TO HIB UNDER DEEMED OR RENAL PROVISIONS

TA     M or F     MQGE (PRIMARY CLAIMANT)

TB     M or F     MQGE AGED SPOUSE (FIRST CLAIMANT)

TC     M or F     MQGE DISABLED ADULT CHILD (FIRST CLAIMANT)

TD     M or F     MQGE AGED WIDOW(ER) (FIRST CLAIMANT)

TE     M or F     MQGE YOUNG WIDOW(ER) (FIRST CLAIMANT)

TF     M     MQGE PARENT (MALE)

TG     M or F     MQGE AGED SPOUSE (SECOND CLAIMANT)

TH     M or F     MQGE AGED SPOUSE (THIRD CLAIMANT)

TJ     M or F     MQGE AGED SPOUSE (FOURTH CLAIMANT)

TK     M or F     MQGE AGED SPOUSE (FIFTH CLAIMANT)

TL     M or F     MQGE AGED WIDOW(ER) (SECOND CLAIMANT)

TM     M or F     MQGE AGED WIDOW(ER) (THIRD CLAIMANT)

TN     M or F     MQGE AGED WIDOW(ER) (FOURTH CLAIMANT)

TP     M or F     MQGE AGED WIDOW(ER) (FIFTH CLAIMANT)

TQ     F     MQGE PARENT (FEMALE)

TR     M or F     MQGE YOUNG WIDOW(ER) (SECOND CLAIMANT)

TS     M or F     MQGE YOUNG WIDOW(ER) (THIRD CLAIMANT)

TT     M or F     MQGE YOUNG WIDOW(ER) (FOURTH CLAIMANT)

TU     M or F     MQGE YOUNG WIDOW(ER) (FIFTH CLAIMANT)

TV     M or F     MQGE DISABLED WIDOW(ER) FIFTH CLAIMANT

TW     M or F     MQGE DISABLED WIDOW(ER) FIRST CLAIMANT

TX     M or F     MQGE DISABLED WIDOW(ER) SECOND CLAIMANT

TY     M or F     MQGE DISABLED WIDOW(ER) THIRD CLAIMANT

TZ     M or F     MQGE DISABLED WIDOW(ER) FOURTH CLAIMANT

T2-T9     M or F     DISABLED CHILD (SECOND TO NINTH CLAIMANT)

W     F     DISABLED WIDOW, AGE 50 OR OVER (FIRST CLAIMANT)

W1     M     DISABLED WIDOWER, AGE 50 OR OVER (FIRST CLAIMANT)

W2     F     DISABLED WIDOW (SECOND CLAIMANT)

W3     M     DISABLED WIDOWER (SECOND CLAIMANT)

W4     F     DISABLED WIDOW (THIRD CLAIMANT)

W5     M     DISABLED WIDOWER (THIRD CLAIMANT)

W6     F     DISABLED SURVIVING DIVORCED WIFE (FIRST CLAIMANT)

W7     F     DISABLED SURVIVING DIVORCED WIFE (SECOND CLAIMANT)

W8     F     DISABLED SURVIVING DIVORCED WIFE (THIRD CLAIMANT)

W9     F     DISABLED WIDOW (FOURTH CLAIMANT)

WB     M     DISABLED WIDOWER (FOURTH CLAIMANT)

WC     F     DISABLED SURVIVING DIVORCED WIFE (FOURTH CLAIMANT)

WF     F     DISABLED WIDOW (FIFTH CLAIMANT)

WG     M     DISABLED WIDOWER (FIFTH CLAIMANT)

WJ     F     DISABLED SURVIVING DIVORCED WIFE (FIFTH CLAIMANT)

WR     M     DISABLED SURVIVING DIVORCED HUSBAND (FIRST CLAIMANT)

WT     M     DISABLED SURVIVING DIVORCED HUSBAND (SECOND CLAIMANT)