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Contact Us: Florida Blue Quick Reference Guide

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Contact Name Contact For Phone / Email / Website
BlueCard® Eligibility
  • Out-of-Area Member Benefit and Utilization Management Questions

800-676-BLUE (2583)

Website: Availilty®

Care Management/Disease Management

Members with an active health plan policy are eligible for referral into our Care Management Programs.  Any Acute or Chronic Condition, or Event that would benefit from engagement with a Registered Nurse; is an appropriate referral.  We  focus in and target the top 5 Chronic Conditions, High Cost, High Risk, and select Specialty diagnoses for outreach calls.

  • Complex Case Management/Transplant
  • Oncology Case Management
  • Neonatal Intensive Care Unit (NICU)
  • High-Risk Maternity Program
  • Chronic Condition Management
  • Medicare Advantage Care Programs

Care Management

Medicare Advantage

Transplant Requests

Utilization Management
  • Preservice Medical Review - Prior Authorizations and Referrals
  • Concurrent Review - Inpatient Acute or Sub-Acute Admissions
  • Peer to Peer Review – Only for Florida Blue Denied Authorizations

*South Counties include:

Miami-Dade, Monroe, Broward, Palm Beach, Martin, St. Lucie, Okeechobee, Indian, Collier, Lee, Charlotte, Glades, Hendry, Hardee, Desoto, Manatee, Highlands, Sarasota, Pinellas, Hillsborough, Hernando, Pasco

 

**North Counties include:

Nassau, Duval, St. John, Clay, Putnam, Baker, Union, Bradford, Alachua, Marion, Columbia, Gilchrist, Levy, Citrus, Hamilton, Suwannee, Dixie, Escambia, Santa Rosa, Okaloosa, Walton, Holmes, Washington, Bay, Jackson, Calhoun, Gulf, Gadsden, Liberty, Franklin, Leon, Wakulla, Jefferson, Taylor, Madison, Lafayette, Orange, Osceola, Polk, Flagler, Volusia, Lake, Sumter, Brevard, Seminole

Preservice Medical Review

  • Phone: 800-955-5692 (Use Availity®1 to enter your authorizations, referrals, and inquiries)
  • Transplant Requests Phone: 844-701-2583
  • Peer to Peer Phone: 800-955-5692
  • General/VPCR/VPSS Fax: 877-219-9448
  • Prescription Fax: 904-905-9849
  • Transplant Fax: 904-357-6331
  • Medicare Advantage, Florida Blue Medicare℠, Medicare PPO Medical Fax: 904-301-1614
  • Medicare Advantage, Florida Blue Medicare Part B Rx Fax:  904-357-6699
  • FEP Preservice/VPCR Request Fax: 866-441-1569
  • FEP Preservice/VPCR Request Fax: 866-441-1569
  • State Account Preservice/VPCR Request Fax: 866-441-1568

Concurrent Review Fax numbers:

  • Med Advantage: 954-714-4109
  • Statewide Discharge Census: 888-757-4921
  • Federal & State Employees: 850-479-6686
  • Commercial South* Region: 813-806-1428
  • Subacute Care South* Region: 954-714-4143
  • Commercial North** Region (includes FL Travelers): 407-804-4432
  • Subacute Care North** Region (includes FL Travelers): 305-716-2731
  • Subacute Care Med Advantage: 813-806-1277
  • Out of State Residents: 904-357-6087

Note: include your authorization number on the medical records being faxed

Contact Center

*Availity Transaction ID or Provider NPI required
  • Claims Payment
  • Eligibility and Benefits
  • Authorizations and Referrals
  • Contract Inquiries (Provider Contracting, Provider Practice Changes)
  • Availity Issues
  • Dental Inquiries

Customer Service Phone: 800-727-2227 (then say one of the choices)

Fee Schedule Request Form Website: floridablue.com/providers/forms

Federal Employee Program® (FEP)
  • New Directions Behavioral Health Prior Approval
  • Care Coordination / Case Management
  • Prior Authorization

New Directions

 

Care and Case Management Phone: 800-337-2204

Prior Authorization Phone: 800-955-5692

Dental
  • Customer Service: Claims and Eligibility/Benefits
  • Contract and Fee Schedule Inquiries
  • Fee Schedule Requests

Customer Service

 

Contract and Fee Schedule Inquiries

Fraud / Abuse Reporting Fraud and Abuse

Phone: 800-678-8355

Email: specinvestunit@bcbsfl.com

Healthy Addition Prenatal Program

Phone: 800-955-7635, Option 6

Email: healthyaddition@bcbsfl.com

IRS Form 1099 Questions Regarding Form 1099 Email: 1099admin@bcbsfl.com
Revenue Program Management
  • Medicare / Commercial Risk Adjustment Education
  • Comprehensive Quality and Risk Program (CQRP)
  • Provider Reimbursement Payment Programs
State Employees State Employee Group Inquiries

Phone: 800-825-2583

Website: floridablue.com/state-employees

 

 

Florida Blue Vendor Quick Reference Guide

 

Contact Name Contact For Phone / Email / Website
Alignment Health BlueMedicareSM Preferred HMO in Clay, Duval, Sarasota, Pinellas and Manatee Counties Phone: 844-783-5191
American Specialty Health Chiropractic Services and Massage Therapy (performed by chiropractor) for claims processing, utilization management services and benefits

Phone: 800-972-4226

Website: ashlink.com

Availity

Non-Emergent Cardiology Services

Phone: 800-AVAILITY / 800-826-4548

Website: availity.com

Availity1 Technical Support / Self-Service Tools

Phone: 800-AVAILITY / 800-282-4548

Email: support@availity.com

Blue Canadian Travel Insurance 
  • Customer Service
  • Pre-approval of Medical Services

Customer Service Phone: 800-727-2227

Pre-approval

Blue TPA Canadian Travel Insurance 
  • Customer Service
  • Pre-approval of Medical Services

Customer Service Phone: 800-995-1683

Pre-approval

CareCentrix®
  • Durable Medical Equipment (DME)
  • Home Health
  • Home Infusion Coordination
  • Orthotics and Prosthetics

Phone: 877-561-9910

Fax: 877-627-6688

Website: carecentrixportal.com

CareCentrix Sleep Management Sleep Management Program

Phone: 855-243-3326

Fax: 855-243-3344

Website: sleepsms.com

Caremark Specialty Pharmacy Services
  • Specialty Pharmacy Program
  • Hemophilia Program
  • Stock Replacement Program

Phone: (866) 814-5506, Options 1 and 4

Fax: (866) 249-6155

FEP Plan Phone: (877) 727-3784

Council for Affordable Quality Healthcare (CAQH)
  • Credentialing Technical Support
  • Fax Supporting Documentation

Phone: 888-599-1771

Fax: 866-293-0414

Email: Caqh.updhelp@acsgs.com

Webpage: upd.caqh.org/oas

CoverMyMeds® Retail Pharmacy / Part D Electronic Prior Authorizations

Phone: 866-452-5017

Webpage: covermymeds.com/main/partners/floridablue

Dermatology Network Solutions (DNS) / Podiatry Network Solutions (PNS)
  • Dermatology Network (South Florida)
  • Podiatry Network (South Florida)

Dermatology Network Phone: 844-222-3535

Podiatry Network Phone: 844-222-3939

Dermatology and Podiatry Email: info@pns-mgmt.com

eDispense (EDVM) Vaccine Manager

Phone: 866-522-3386

Webpage:https://www.floridablue.com/disclaimer?destination=https://www.transactrx.com

Eye Management, Inc. (EMI) Ophthalmology Services (South Florida)

Phone: 800-329-1152

Fax: 305-620-5873
Health Dialog Care Navigation Capability Phone: 877-789-2583
Implantable Provider Group (IPG) Implantable Device Procurement Program

Phone Toll Free: (866) 753-0046

Phone: (770) 753-0046

Fax: (866) 753-0194

Email: info@ipg.com

Webpage: www.ipg.com

Magellan Rx ManagementSM Physician Administered Drug Program (PADP)

Phone: 800-424-4947, Option1

Fax: 888-656-6671

Website: ih.magellanrx.com

MES Solutions
  • Adverse Determination Disputes
  • Billing Dispute External Review

Phone: 800-437-8583

Fax: 888-868-2087

Email: info@messolutions.com

Website:  mesgroup.com

My Home Doctor PATCH Program (South Florida)

Phone: 888-696-4322 

Email: customerservice@myhomedoctor.com

New Directions Psychiatric or substance abuse needs Phone : (866) 730-5006   (NDBH)
Prime Specialty / Alliance RX Provider Administered

Phone: (866) 260-0452

Fax: (877) 239-9285

1 Availity, LLC is a multi-payer joint venture company. For more information or to register, visit availity.com. Florida Blue is an independent licensee of the Blue Cross and Blue Shield Association.

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