How to Identify Members
When members arrive at your office, remember to ask to see their current member identification (ID) cards at each visit. This will help you identify the product the member has and get dental plan contact information. It will also help you with filing claims. Please note that all ID cards do not look the same and are for identification purposes only. They do not
guarantee eligibility or payment of your claim.
Important Facts about the ID Card Prefix
• Using the correct ID card prefix is critical for electronic routing of specific HIPAA transactions
• It is important to capture all ID card data at the time of service.
• Do not assume that a member’s ID card number is his or her Benefits Identification Number.
• Be sure all of your system upgrades accommodate the ID card prefix and all characters that follow it.
• Do not add, delete or change the sequence of characters or numbers in a member’s ID card number.
• Make copies of the front and back of the ID card. Share this information with your billing staf
Here is an explanation of each filed on the ID card:
• ID – The member’s BlueChoice identification number.
• EPO – Indicates the member is enrolled in an Exclusive Provider Organization plan. Members must stay in-network in order to receive benefits for covered services.
• HMO – Indicates the member is enrolled in an HMO plan. Members must select a primary care physician who
is then responsible for providing or coordinating all of their health care.
• PPO – Indicates the member is enrolled in an open access plan.
• HDHP – Indicates the member is enrolled in a high deductible health plan. Works the same as regular ADVANTAGEplus and CarolinaADVANTAGE, except member must meet a high deductible amount that will be indicated on the card. Deductibles do not apply to preventive care.
• Rx – Indicates the member is enrolled in a pharmacy benefit plan.
Please refer to our 2018 Member Identification Card Reference Guide on www.BlueChoiceSC.com if you have questions about BlueChoice ID cards.
SAMPLE 3 character prefix
INDIVIDUAL AND SMALL GROUP BUSINESS (1-20 EMPLOYEES)
YDF Small group PPO plans purchased on the Health Care Exchange
YDG Individual PPO plan purchased on the Health Care Exchange
YDK Individual PPO plan purchased through BCBSMT
YDI Multi-State PPO Plan
YDR Blue Focus POSSM (Point of Service) purchased on the Health Care Exchange (Narrow Network)1
YDN Blue Focus POS (Point of Service) purchased through BCBSMT (Narrow Network)1
YDJ Medicare Advantage PPO Plan
YDV Medicare Advantage Pipe Trades Trust
YDU Medicare Supplement
GROUP BUSINESS (51+ EMPLOYEES)
BXB First Interstate Bank R Federal Employee Program (FEP)
BHX Benefis Health System (Custom Network)2 HWZ Blue OptionsSM Point of Service (Narrow Network)1
G8F City of Great Falls YDC Employee Healthlink PPO
GBA Glacier Bancorp, Inc. YDD Healthlink PPO
M2X Marcus Daly Memorial Hospital YDE Traditional (including HMK)
MVA Montana University System YDM Yellowstone County
NNW Northwestern Energy YDS Blue Preferred PPOSM
PTX Pipe Trades Trust
Blue Cross and Blue Shield of Vermont (Blue Cross VT) Prefixes
When you contract directly with Blue Cross VT regardless of in the state in which you provide services, you must submit all claims for these prefixes to Blue Cross VT. Some exclusions apply for durable medical equipment suppliers, independent clinical laboratories, and specialty pharmacies. Please refer to the online
provider handbook for complete details.
Blue Cross VT handles care and case management, if/when applicable, for these prefixes. In some instances, we have partners that handle utilization management reviews,such as AIM Specialty Health for radiology services or Optum Rx for pharmacy services.
Our Blue Cross VT customer service team handles inquiries related to these member prefixes. The following prefixes are active as of January 1, 2022:
Prefix Product and/or Account
EVT State of Vermont Select Care (EPO)
FVT State of Vermont Total Choice (Indemnity)
R Federal Employee Program (PPO)
VEI Vermont Education Health Initiative (EPO)
ZIA BCBSVT – Indemnity
ZIB BCBSVT – Vermont Blue 65/Vermont Medigap Blue
ZID BCBSVT Preferred Provider Organization (PPO)
ZIE BCBSVT – The Vermont Health Plan (TVHP)
ZIG BCBSVT –Qualified Health Plan, Small Group (EPO)
ZIH BCBSVT – Vermont Health Partnership (VHP)
ZII BCBSVT –Qualified Health Plan, Individual (EPO)
ZIJ BCBSVT – VHP HMO
ZIK BCBSVT – EPO
ZIL BCBSVT – EPO without Primary Care Provider
ZIU University of Vermont (UVM) (PPO)