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.