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Providers
November 2024
In This Issue
► November news: Executive summary
► Fee schedules now available via Availity Essentials portal
► Prefix replacements for 2025
► 2025 Provider Operating Guide preview starts December 2
► More biosimilars get preferred status for 2025
► Quarterly fee schedule updates effective January 1
Introducing new member ID prefix replacements for 2025
We have been moving our member data to a more robust platform. As we do this, we may assign a new member ID prefix in some cases. This helps us temporarily track members in both systems for current and historical data.
Use the prefix that’s valid for the date of service
Please take care that the prefix you use for searches or claim submission is valid for the date of service. To help you with this, we post our prefix list and a prefix replacement table on the Member ID Prefixes page. You can check which prefixes were updated as of a certain date.
Why it matters
1.
Eligibility/Benefits
If you search with a member ID prefix that isn’t valid for the service date, you will receive an “inactive” status.
2.
Your claims must have the correct prefix for the date of service
If you submit a claim using a prefix that isn’t valid for the service date, you will receive a message advising you of the prefix replacement:
“The member ID prefix you entered does not match the prefix on file for this service date. Please resubmit with the correct prefix (see azblue.com/prefix).”
3. Remits
• On the Availity Essentials™ provider portal, you may want to use the service date filter if you’re searching by member ID. There are many other search options.
• On the AZ Blue provider portal, you may want to do two searches — one for payments issued before the date the account was updated and one for payments issued on or after that date. Or you can simply search specific dates rather than date ranges.
Effective January 1: Four new prefix replacements
You can check prefix replacements on the table below, including the four that become effective January 1, 2025. You can also find this table on our Member ID Prefixes page.
Original Prefix Replacement Prefix (applicable as stated in red below)
Before 01/01/2025 Z3J → S8C New as of 01/01/2025
The S8C prefix change applies only to certain members.
Before 01/01/2025 Z8M → M2I New as of 01/01/2025
The M2I prefix change applies only to certain members.
Before 01/01/2025 XBK → KZW New as of 01/01/2025
The KZW prefix change applies only to certain members.
Before 01/01/2025 KST → KIP New as of 01/01/2025
The KIP prefix change applies only to employee group 029653.
Before 06/01/2024 Z4P → SMP As of 06/01/2024
The SMP prefix change applies only to certain members.
Before 01/01/2023 PMA → Z9P As of 01/01/2023
The Z9P prefix change applies only to certain members.
Before 01/01/2023 XBM → Y4M As of 01/01/2023
The Y4M prefix change applies only to certain members.
Before 01/01/2023 XBN → N4Z As of 01/01/2023
The N4Z prefix change applies only to certain members.
Before 01/01/2023 XBP → P9H As of 01/01/2024
The P9H prefix change applies only to certain members.
Expired 01/01/2024 M2V →
M3V →
M4K →		 M2K As of 01/01/2024
The M2K prefix is assigned to all members with an AZ Blue Medicare Advantage HMO plan.
Expired 01/01/2020 XBU As of 01/01/2020
Don't use the XBU prefix for Medicare Advantage members. All 2025 Medicare Advantage members have prefix M2K.
Questions?
For more information about member ID prefixes, visit our Prefix page. If you have questions, feel free to contact us at 1-844-995-2583 or reach out to your Provider Relations Contact.
In This Issue
► November news: Executive summary
► Fee schedules now available via Availity Essentials portal
► Prefix replacements for 2025
► 2025 Provider Operating Guide preview starts December 2
► More biosimilars get preferred status for 2025
► Quarterly fee schedule updates effective January 1
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