Prefix not found? What to do next

AlphaPrefix only lists prefixes we can tie to an official source, so coverage is partial. If your lookup comes back empty, that does not mean the prefix is invalid. It means we have not documented it yet, or something about the ID needs a second look. Work through the steps below.

Step 1: Check what you typed

Enter only the first three characters of the member ID, exactly as they appear on the card. The prefix is in the first three positions of the ID number.

Look again at any character that could be a letter or a digit. Since 2018, some prefixes have mixed letters and numbers, so a digit in the prefix can be correct.

Step 2: Is it a Federal Employee Program ID?

If the ID starts with the letter "R" followed by 8 digits, it is a Federal Employee Program (FEP) ID. FEP IDs do not have a three-character prefix, and FEP is excluded from BlueCard, so there is no prefix to look up. Follow the instructions on the FEP card to verify eligibility, submit claims and find plan contact details.

Step 3: Is it a product that has no prefix?

One Blue plan's ID card guide lists cards that do not carry an alpha prefix:

• Stand-alone vision and pharmacy delivered through an intermediary model
• Stand-alone dental products
• The Federal Employee Program

For these cards, follow the instructions printed on the card. Separately, some members carry outdated cards that may not show a prefix, so ask for the most current card.

Step 4: Do not fill the gap yourself

Each of these points comes from one of the plan manuals we cite:

• Do not make up a prefix.
• Do not guess one or try to work it out from the patient's home plan.
• If the card has no prefix, do not create one or use one from another member's card, even from the same plan. This can delay inquiries and claims.
• Claims with incorrect or missing prefixes or member IDs cannot be processed.

Step 5: Verify with the plan

Read the card. The card's own instructions are the first place to look, especially for cards without a prefix.

Call BlueCard Eligibility for out-of-area members. Several Blue plans direct providers to BlueCard Eligibility at 1-800-676-BLUE (2583) to verify eligibility and coverage. Have the member's prefix ready. The line routes eligibility, benefit and pre-certification or referral authorization inquiries to the member's plan. One plan's manual says it is not for claim status.

Ask your local Blue plan. One plan's manual describes your local plan as your sole contact for claims payment, adjustments and issue resolution. Two plan manuals tell providers who have trouble getting eligibility information to record the prefix and report it to the local plan. Highmark tells its providers to look to Highmark first for help with out-of-area members.

Step 6: Help us fill the gap

If you confirm the plan for a prefix we do not list, and you have a link to an official source that states it, please send it to us. See our corrections page. Do not send member IDs or any patient information.