KQE = Minnesota RCA Ohio You should direct requests for coverage for drugs provided through the Michigan Department of Community Health to Magellan at 1-877-624-5204. GZM Massachusetts CZK Virginia UDW-Washington (State grp) XJG Florida SDY Blue Cross Fl SZQ Ohio FLO Ohio UAY North Carolina All Rights Reserved. RXD Maryland (Carefirst) IPN Pennsylvania (Highmark) BTW California XUH Louisiana [Thanks Stacy!] FWY Illinois GGT New York (Empire) IBN Blue Cross MI GSK Pennsylvania (Capital) NDA = BCBS of ND Medicare Blue PPO UEF Massachusetts PAS Illinois You can refer to the Blue Cross Complete Pharmacy Prior Authorization Guidelines (PDF) to see which drugs require prior authorization and what the criteria are for each drug. XVD BC SmartValue (Medicare Advantage Plan) endobj CCC, CCG = Highmark PEG Texas NGN Massachusetts NNR Pennsylvania NLQ Washington/Alaska (Premera) IBF New York (Excellus) FCG Maryland CYL New York (Excellus – Rochester Region) RBG Illinois CLV Texas YTX Virginia ENF Texas BCBS CALIFORNIA 800 677 6669/ PRECERT 800 274 7767 SXH, CYH, ENA, WWP, AET, BCI, XDP, CPR, GES, AIH ZFD New York (Excellus) CRW New York (Excellus) VMC Alabama [Thanks Veda!] CPV New York (Excellus – Rochester Region) JWA Kansas City KCM Pennsylvania (Highmark) CRL New York (Excellus) XBH Arizona IMA New York (Excellus) TZU Massachusetts DCN Nebraska RIX New York (Excellus) GHS New York (Excellus) CID North Carolina PCW New York (Empire) RAI New York (Excellus – Rochester Region) FDU = Anthem (UBEW) EMI Ohio GLK New York (Excellus – Rochester Region) ZFB New York (Excellus) RMP New York (Excellus – Rochester Region) HLE New York (Excellus – Rochester Region) ZIA Vermont LKL Maryland SOD Delaware TYS Iowa (Wellmark) Site Map | Feedback | Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org, Blue Cross Complete of Michigan (formerly BlueCaid of Michigan) prescription drug program (PDF), Blue Cross Complete Preferred Drug List (PDF), Michigan Department of Community Health - Health Plan Carve-Out (PDF), Blue Cross Complete Pharmacy Prior Authorization Guidelines (PDF), Blue Cross Complete Prior Authorization Request form (PDF), Important Information About Medicare Plans. CZQ Ohio BCBS OKLAHOMA YUP PHW Maryland (Carefirst – National Capitol Area) DTE Ohio RYA South Carolina UBS Georgia (or California, depending on which 800 number you call…) MBU Blue Cross MA XNS Idaho (Regence) CENTRAL NY BCBS 800 311 3536 YNT, YNY, YNZ, YOU, YOM, DHA, YOZ New York (Excellus/Utica) HVL New York (Excellus) HIGH MARK BCBS PENNSYLVANNIA 800 283 3792 GBF GEL Georgia ZCL South Carolina YYM Pennsylvania (Highmark) VZR Wisconsin RSP Ohio PEB Penn (Capital) AUX Wisconsin XYA Michigan DLW-Texas NCJ New York (Empire) AGB New York (Excellus) EGS Minnesota EWZ Ohio FDO North Carolina YNA New York (Excellus/Central) YPP North Carolina UAL Illinois [Thanks K. BFO Michigan NPD Nebraska EMPIRE BCBS 800 992 2583 SEP HXU Indiana YLW New York (Empire) CDP New York (Excellus – Rochester Region) FCD Illinois UCE Texas Channin: when there is “AN” following the 3 letter prefix, that is Anthem. XDL California – Blue Cross SJP Alaska (Premera) PGJ Ohio AHD South Carolina EGH North Carolina FTR New York (Excellus – Rochester Region) XVM Maine PMY Missouri (St Louis) XNZ Idaho (Regence) ELK New York (Excellus – Rochester Region) NPA New York (Excellus) KYS New York (Empire) SFZ = BCBS of Illinois, State Farm group VZR Wisconsin �q2Q��(>cR�J��W�$˘XI�{�l�t���1��z��w7p��i' ms'F�;( 2.H�i% ��AI���a�$ԾgI��{!DI(���+ռ@z8��<0�N���( �#��P�:@ �)��JƦ��C�����"��օJ���Mؗ�� @�|��F��,0[�"0(o�+oږ�B�V��&�$��Wv�^{��9mKQ��2�jV1���쁎9��o��6��������fµ-p�'t�� �����A�Lq6݃� � gD��1�B��.`���p/�r�J���Ȼ��a�����7�U ����^4�gm�>�xK���j;$��% �Y����%;�נ!e��Pͳ���k�Ð4H`�fjCj�&��2HEm��P���P����� ���۪�]$=��6�`F�Nn��t���)g���u��[G0vph���"}�p�r��{���eqn�j�o�ŷ(E���,�GOv.�8�`�s5ٹ���n�87|�ƨ,����1YN��3]c�t}�Tw|㻞��|��I�����c��7����˿�f{�`2��D2y���æ-������:�'e`���;�SW�F�S� �׷� ����˚�����Ym�r��wIR�W�}���篷�b)ٜZ.,�5�w'������-A���. PGI Illinois Note that HIV/AIDS and most psychotropic drugs are covered by the Michigan Department of Community Health and are not payable through Blue Cross Complete. great_thingstocome@yahoo.com. 0000001993 00000 n YUN Oklahoma YAG Mississippi BCBS CALIFORNIA TRADER JOES 877 526 3385/PRE 800 LMN = Minnesota (South Central MN Elec Workers) GYA Ohio @m�{��P�д�YY��e���C��tg^!��6���c$�.8z��_�f(JS��+��J�/V��^R�����);ؙ�v��0��sȳ�`���~�6S8�&H�k�5��؜�<7�a�ǹ�w��*+�Le�k�2Ϫꕁ��~F�{=f�Uw��oGd� Y5�1E�6/eo�� ��Gk�?����~K�'�C ^cmʵA@���CΔ��x�Ќ�94O�#C�p&&[�m�v�p�K��%��©�w>��fo����M��m |ZEL��J����������� MTI New York (Empire) GQS New York (Empire) RGN Alabama I have been hunting all over the place for this info. ONC New York (Excellus) AFY Illinois [Thanks MaryBeth!] YPJ North Carolina TEU Alabama YNE New York (Excellus/Central) KEZ CBA Blue (Vermont) CHB Massachusetts AFV New York (Excellus) YJP New York (Western) Walgreens® Specialty Pharmacy, LLC handles mail-order prescriptions for specialty drugs (PDF). KRO Ohio The three-character prefix at the beginning of the member’s identification number is the key element used to identify and correctly route out-of-state claims to the appropriate BCBS Plan. BEK Alabama NMU Tennessee IAZ = Wellmark of Iowa Medicare Blue PPO UTX Ohio To return to our website, simply close the new window. ��@E:� �dX�m����z�k�X�K���3�&.� �\�/,Nb���Ѭ�\�4[ 1� ��#CC��� �-2 ZAT Pennsylvania (Northeast) WCC Illinois HIGH MARK BCBS FED EX 888 280 9835 (363 PLAN CODE) FXM WGN New York (Excellus – Rochester Region) YHC New Jersey [Thanks Kim!] RHA North Carolina YBC Kansas City BFL Florida MMM-3M MINNESOTA MPA Mississippi logo and a three-digit alpha prefix similar to ID cards you may see for members with Blue Cross and Blue Shield of Louisiana commercial plans. ARH Virginia BXZ Ohio BCBS CALIFORNIA 800 234 0111 / precert 800 234 0111 opt 2 WRXA GIC Illinois ZHB Utah (Regence) NWO Ohio UHL Arizona Thanks! UCM Illinois BPM New York (Excellus) RAO Kansas TOE Kansas DZV Ohio XSV Kansas TTI Alabama DSS California (Blue Cross) XFW Colorado HIH California (Blue Cross) KSM New York (Excellus) These are all confirmed either via phone calls or an EOB: ARM = AK STEEL (FKA ARMCO), Anthem (I think AKG is also Anthem/AK Steel in Ohio, I have run into a few AK_ that are from this employer) YLG New York (Empire) EMPIRE BCBS 800 EQX YLS New York (Empire) TZD Ohio CKP New York (Excellus) IEV Alabama [Thanks Katie!] PEM = Minnesota (Pemstar, Inc. employees) UNE Nebraska