Share these July 1 prefix updates with your teams.
Please note the following prefix updates and share them with your teams:
New prefix replacement: XBO → HMO
Some plans with the XBO prefix will begin using the new HMO prefix on 7/1/25. You must use the correct prefix for the date of service when you’re validating eligibility and submitting claims.
Discontinued prefixes: XBD and KGM
These will remain active for previous dates of service. Members with the KGM prefix will start using the AOZ prefix on 7/1/25.
Prefixes for “Strategic Hub” plans: AOZ, AZI, AZK, and IVR
These plans are administered in partnership with another Blue Plan (Blue Cross Blue Shield of South Carolina). See Details
To download the updated prefix list and view the table of all prefix replacements, visit our Member ID Prefix page.
Get ready! CMS risk adjustment audits to begin soon.
CMS has announced an aggressive audit schedule for calendar years 2018-2023. This means you may receive urgent records requests for AZ Blue Medicare Advantage members over the next several months. We will fax these to you with a 10-day turn around time.
Please note: CMS requires medical records for Medicare members to be retained for 10 years.
Be sure to include the authorization number in your claims when applicable. This helps you avoid unnecessary denials. For more tips, see our checklist for clean claims.
Behavioral health learning opportunity: Check out these free continuing education courses and resources from the American Diabetes Association® and learn how the right behavioral health support can help patients living with diabetes.
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Grand Rounds summer pause: Look for sessions to start again in September. You can still access our previous presentations at Arizona Community Grand Rounds.
The MCG care guidelines are the proprietary and copyright-protected information of MCG Health, part of the Hearst Health network.
American Diabetes Association is a trademark of American Diabetes Association, Inc.
Blue Cross, Blue Shield, and the Cross and Shield Symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
