po box 880 farmington mi 48331 payer id

Whether online, through your practice management system, vendor or direct through a data feed, EDI ensures that your claims get submitted quickly. Not only did I arm her with my photo ID, the confirmation number for the . ZIP code 48331 is located in southeast Michigan and covers a slightly less than average land area compared to other ZIP codes in the United States. First Name: Required Last Name: Required Company Name: Required Title: Email: Required Phone: Required Comments: Required Type of inquiry: Answer the question below: Contact - Lucent Health Because most dental offices are already computerized, it's just a matter of a software program and a clearinghouse. Robert Hund Inc, Farmington, MI - PO Box 880 - Newspaper Advertising to see if your clearinghouse partner is on the list. Providers can file EDI: Payer ID IH400 . hbbd```b``6kA$bv &A$0"YL`6ED2 $LUl/0$3m` 7l Download the free version of Adobe Reader. Essentia Choice Care with Medica (Commercial) Overnight payments for Blue Care Network groups JPMorgan Chase Blue Care Network Lockbox 33608 1 Village Center Drive This field is for validation purposes and should be left unchanged. Medica Choice Passport Oak Park, MI 48237-7705. BANKERS PO BOX 37511 OAK PARK MI 48237 98999 0248 X A.B.S. P.O. Learn about our HSA &HRA plans, Dental &Vision offerings, Pharmacy solutions, and Care Management, Learn about becoming a self-funded employer to save money and add value, IBA works closely with each individual client to establish Stop-Loss plans and uncover billing errors. Payer ID Claim Office # Type Name Address City State Zip 98999 2691 X A.B.S. US506049: Presentation - Robert Bosch LLC (HQ) . providers - IBA TPA box 7186 boise id 83707 8007867930 10079 abs po box 30570 phoenix az 85046 6238897200 . Medica with CHI Health Fact Sheet (Accountable Care System Product) 1 year ago Reply. Payer ID: IMPORTANT: Please refer to Member ID card for changes effective on January 1, 2021, as the Payer IDs are not interchangeable. Download a form for non-covered services. If you have questions or dont understand the reports, contact your clearinghouse for clarification. Fax | 205.871.3259, 24/7 access to benefits and eligibility through the portals on this website or our automated response system (FaxBack) which can be reached by calling our office and following the prompts, EVERYTHING YOU WANTED TO KNOW ABOUT TPAS BUT WERE AFRAID TO ASK. Payer# 05030 IL Individual Plans P.O. Login Username Password Submit Forgot your username or password? A very large employer asked SPBAs Past President Fred Hunt what criteria a consultant should recommend back to the employer whether or not to hire a TPA. Eagan, MN 55121, Note: When submitting claims under this payer ID, use only the 10-digit member ID. 39372.Rev003 12.17.2020 Was this answer helpful? 2023 Please ensure the proper claims address and payer ID is used. Attn: Claims Department. The next screen will display the Other Insurance information, along with specific Payer IDs for the . Billing and Payments | Meridian Complete of Michigan Schedule an Appointment with a licensed insurance agent. Empower by Medica Review which codes require additional submissions. PDF Contact Information for - Delta Dental AA002. HOW DO I BECOME A PREFERRED PROVIDER? Medica Elect and Medica Essential Medica with CHI Health Direct Primary Care (DPC) s?|S#FX5pgdod2_}p#fuVxujyDlFG\{NRWI~]BS1m"V+{uvo5k$S_!uOO_77*^sV4^mDa9z){],KhJ`P4PnJh/};--4wc8 ?NM7tT*ym:Q=JAf^&wc)EoehM?UT5HhJ{P&Zo8[0[277D}oIKR ^k5$&h"^{1C?UMPG= BE::h{c$&/&/5v4 v7.F#urwyq} %. Or, you may call DASI 24/7 at 800-462-7283 to check the status of claims, including those submitted electronically. 4 0 obj Understand how to submit claims for patients with multiple benefit plans. Get paid fastersign up today for this free service. We are excited to share that MeridianCare, a WellCare company, is changing its name to WellCare, effective January 1, 2020! These plans make it easy to receive Delta Dental coverage and protect your health. Please email CA.ITHelpDesk@lucenthealth.com if you have forgotten your username or need to have your password reset. PDF Cofinity Platform Migration Fully Migrated Payers hb```f`` @1V 0&>TY6@Sk~dp;I;Egki``Ft "UY63Leg,l9 3'C {&AQ730 XqQ? First Name: Required Last Name: Required Company Name: Required Title: Email: Required Phone: Required Comments: Required Type of inquiry: Answer the question below: Medica Signature Solution Make sure the dentists business name and address on your electronically submitted claims is exactly the same as you have registered with your software vendor, the clearinghouse and Delta Dental. LifeSmile is an oral wellness program that helps you focus on your oral health and well-being with education and tips for improving and maintaining good dental health habits. Billing and Payments | Meridian Complete of Illinois PDF Payer Connection Payer List Limitations, restrictions, and patient pay amounts may apply. BCBS EDI Payer ID Listing by Name - Office Medicine . For DOS on or after July 1, 2021. 2020 Provider Manual. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. Meridian follows State Medicaid guidelines for claims payment. 49438 advantage by bridgeway healthcare po box 3060 farmington mo 63640 8664753129 95327 adventist risk mgmt p.o. Language Assistance & Notice of Nondiscrimination, Providers must use a standard CMS 1500 Claim Form or UB-04 Claim Form for submission ofclaims to Meridian, Providers must use industry standard procedure and diagnosis codes such as CPT, Revenue, HCPCS and ICD-10when billing Meridian, Specialty physician claims should include a PCP referral form and/or a corporate prior authorization number for payment, Providers may also submit and check the status of claims electronically via the secure Meridian, Claim must be original, using national or state form types as applicable. Claim Adjustment or Appeal Request Form (DOC). PO Box 211435 . Select by Medica, Address for Claims and Claim Appeals (paper submission and correspondence), Medica Billing and Payments - Michigan Meridian Shop; Pruducts. Submit all initial claims for adjucation through electronic claims submission or by mail to: If you are re-submitting a claim for a status or a correction, please indicate Status or Claims Correction on the claim. Llame al. Medica Choice Care MSC+/Minnesota Senior Care Plus (MSC+) Elevate by Medica IBA | Privacy Policy | Terms of Use | Site by Lightmatter. If you include the 2-digit suffix for the member, the claim will reject as member not on file, Note: When submitting claims under this payer ID, use only the 10-digit member ID. Cypress Benefits Administrators Po Box 880; Farmington; MI; 48331-0000 Delta Health Systems Po Box 780; Stockton; CA; 95201-0780 (800)418-5409 Infusion Therapies and Specialty Medication Clarification. Thank you! 2021 at 2:32 pm FARMINGTON, MI 48334 The address is: The DharmaShop 24148 Research Drive Farmington Hills, MI 48335. Lucent Health Po Box 880 Farmington Mi 48331 - Explore Recent PO Box 3060 Farmington MO 63640 For 2020 dates of service, please continue to use this address: MeridianComplete 1 Campus Martius, Suite 720 Detroit, MI 48226 Attn: Claims Department If you are re-submitting a claim for a status or a correction, please indicate "Status" or "Claims Correction" on the claim. Farmington, MO 63640-3823 . %%EOF endstream endobj 1438 0 obj <. Monday-Friday from 8 a.m. to 8 p.m. (member); 8:30 a.m. to 8 p.m. (provider). endobj po box 880 farmington mi 48331 8555560285 0001121900 dart management corp (dmc) 500 hogsback Blog; Contact; Understanding Your Dental Plan; DeltaDental.com; Find My Delta Dental; Medica Advantage Solution PartnerCare HMO I-SNP 3. Meridian is currently accepting electronic claims from the following clearinghouses: Availity Customer Support: 800-282-4548 Claim Types: Professional/Facility Payer ID: IMPORTANT: Please refer to Member ID card for changes effective on April 1, 2022, as the Payer IDs are not interchangeable. Impact Health Sharing Providers Box 880. On or after Jan. 1, 2021: . Cypress Benefit Administrators Address: PO BOX 880 FARMINGTON, MI 88056-0000 Website: http://www.cypressbenefit.com Telephone: 855-556-0285 Mail Order Disposable Medical Supplies Are you very busy? Medica Focus Your submission has been received! PO Box 0392 Milwaukee, WI 53201 www.auxiant.com 800-475-2232 4/1/2019 AUXIANT-MEDICAL BENEFIT ADMINISTRATORS MBA02 36326 PO Box 0392 Milwaukee, WI 53201 www.auxiant.com 800-475-2232 4/1/2019 CYPRESS BENEFIT ADMIN CBA03 88056 Cypress Benefit Administrators P.O. Peace Corps has contracted with International Medical Group (IMG) to administer the Peace Corps healthcare program. Post Office in Farmington, MI - Hours and Location - Postal Locations Delta Dental PO Box 9089 Farmington Hills, MI 48333-9089 Call our customer service team at 800-524-0149 for member eligibility, benefits information and claims inquiries. Box 9000 Johnston, IA 50131-9000 800-544-0718 www.deltadentalia.com Payer #CDIA1 Procedure Codes that Require X-ray or Document Submission, Medicaid and Medicare Advantage Non-covered Services Form. you may call the number above, request one at the website link provided above, or email memberservices.mi@mhplan.com. VantagePlus with Medica Something went wrong while submitting the form. Amerisure is a leading provider of commercial property and casualty insurance solutions for U.S.-based construction, manufacturing and healthcare businesses. Can't find what you're looking for? po box 3080 farmington hills, mi 48333. by | Nov 13, 2022 | 401k employer contribution | red mountain park bike trails | Nov 13, 2022 | 401k employer contribution | red mountain park bike trails PO Box 212 stream Samara B. The claim information must be typed, with no hand-written information other than applicable signatures. I've been waiting . Cypress - Lucent Health new address for 2021 . Login, ExpressScripts (ESI). PO Box Online; Lobby has Copier; Lot Parking; Visit our Links Page for Holiday Schedule, Change of Address, Hold Mail/Stop Delivery, PO Box rentals and fees, . If either the provider or chosen clearinghouse has questions about the process of enrolling as an atypical provider, you can contact the Client Services team at 1-800-Availity. All Rights Reserved. For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > HOME; SHOP. Billing and Payments 1030582505 ambetter po box 5010 farmington mo 63640 5010 8776871187 0001198700 ameriben solutions po box 7186 boise id 83707 8007867930 0001114900 america first insurance co po box 16708 jackson ms 39236 8008001397 . 600 Pittsburgh, PA 15202 (412) 2012242 FAX (412) 2012250 LUCE AFMC LUCENT HEALTH (fna) CYPRESS BENEFIT ADMINISTRATORS P.O. Medica Individual Choice Medica Connect And, in the end, faster claims processing means faster payment to you. %PDF-1.5 % Contact - Delta Dental of Minnesota Medica | Claim Submission and Product Guidelines claims. Note: documents in Word format (DOC) require Microsoft Viewer, download word. 812 0 obj <> endobj Claims Submission | Delta Dental of Michigan For certain kinds of drugs, you can use the plans network mail-order services. Medica Solo Meridian may add new clearinghouses from time to time, so please contact Provider Services at 888-437-0606 to see if your clearinghouse partner is on the list. Farmington, MI 48331 www.cypressbenefit.com. Authorizations: Optum 1-800-873-4575, Eligible Chiropractic Codes for Commercial and Individual Plans Only, Altru & You With Medica P.O. Meridian is currently accepting electronic claims from the following clearinghouses: IMPORTANT: Please refer to Member ID card for changes effective on January 1, 2021, as the Payer IDs are not interchangeable. Contracted Enrollment Request Practitioner, Definition of Enrollment, Credentialing, and Contracting, Providers must use a standard CMS 1500 Claim Form or UB-04 Claim Form for submission ofclaims to Meridian, Providers must use industry standard procedure and diagnosis codes such as CPT, Revenue, HCPCS and ICD-10when billing Meridian, Specialty physician claims should include a PCP referral form and/or a corporate prior authorization number for payment, Providers may also submit and check the status of claims electronically via the secure Meridian, Claim must be original, using national or state form types as applicable. Clear Value With Medica endstream endobj startxref %PDF-1.5 % PO Box 9089 Payer ID: 71890 ID: 1234567891 Name: Mayo Medical Plan Page Fact Sheet 2 of 4 . What is a self-funded health plan? Medica Prime Solution box 4088 silver spring md 20914 8004475002 . Instructions regarding resetting your password have been sent to the email address on file. For 2020 dates of service, please continue to use this address: 1 Campus Martius, Suite 710 Detroit, MI 48226 Attn: Claims Department. The contact information is listed below. Michigan. How to Locate Payer ID and Other Health Insurance Information - Michigan Farmington Hills, MI 48333, USA . Please contact the plan for more details. Phone: (248) 476-5555 Payer ID: 94265 + Product Fact Sheets Altru & You With Medica Clear Value With Medica Essentia Choice Care with Medica (Commercial) Medica Choice Passport Medica CompleteHealth Medica Advantage Solution HMO Fact Sheet Sending unnecessary X-rays and information such as reports and periodontal charting delays the processing and your payment. Contact Information for Providers - Delta Dental of Minnesota PO Box 37705. Visibility that unlocks value. PO Box 880. Kompass ID? Rx Bin: 003858 Below is Freds answer. Members > MultiPlan Known Addresses for Amerisure Insurance Company. Note: documents in Excel format (XLS) require Microsoft Viewer, download excel. Rx Group: 3Medica, Medica Behavioral Health (MBH): 1-800-848-8327, PO Box 30757 Balance by Medica Health Net's Electronic Data Interchange (EDI) solutions make it easy for more than 125,000 in our national provider network to submit claims electronically. PDF Third Party Liabilty (TPL) Carrier Information Even if you aren't currently set up for electronic claims submission, mail costs savings alone should nearly pay for a computer system in just one year. 1495 0 obj <>stream Before you start submitting your claims electronically, inform your software vendor. Update: National Provider Identifier (NPI) is required when billing, unless enrolled as an atypical provider. <>/Metadata 9495 0 R/ViewerPreferences 9496 0 R>> Harmony by Medica Heights, IL 60006-1938 AMERICAN HEALTHCARE ALLIANCE. PO Box 2839 If you are interested in electronic claims submission, we encourage you to take a look at ourlist of clearinghouses. Electronic claims ensure greater accuracy, because of built-in checks on claims submission. Call one of our licensed agents at 866-966-9868. PO Box P.O. This evolution allows us to grow and add quality services to our platform of solutions for self-insured employers and covered members. Register Phone: 1-877-268-3384. Read more Lucent Health Completes Brand Transition of Cypress Benefit P.O. %%EOF PO Box 0392 Milwaukee, WI 53201 www.auxiant.com 800-475-2232 4/1/2019 CYPRESS BENEFIT ADMIN CBA03 88056 Cypress Benefit Administrators P.O. 0 ZIP code: 48332-0880. Provider Network Questions: For questions regarding our provider network, or to join the HealthSmart PPO Preferred network, contact HealthSmart Provider Relations at 800-687-0500. Ridgeview Distinct by Medica Eagan, MN 55121 : See details on claim submission and product guidelines. Park Nicollet First with Medica Claims - South Country Health Alliance Medica with CHI Health Review the information in this section before contacting customer service. Salt Lake City, UT 84130, Medica Advantage Solution H0798-002 (HMO I-SNP) Fact Sheet Electronic claims submission is fasteryou and your staff will have more time to devote to your patients and for other responsibilities. Automated system is available 24/7. The top five tips for participating providers. Visit the. Delta Dental has affordable individual dental plans available for you. PDF ACCEPTED INSURANCE - Rocky Mountain Senior Care Copyright 2023 Meridian. Pioneer Precast Concrete LLC > Blog > Uncategorized > butler county community college nursing requirements. Allwell PO Box 3060 Farmington, MO 63640-3800 ATTN: Medical Review Unit . Photo or scanned copies are not accepted. Box 880. Sorry, the page you are looking for doesn't exist. Our clients are always compliant with HIPAA & COBRA requirements. Medica AccessAbility Solution / Special Needs Basic Care (SNBC) It also has a slightly higher than average population density. Delta Dental Michigan - Contact Us International Medical Group PO Box 550, Farmington Hills, MI 48332-0550 Telephone: +1 (855) 851-2974 (USA & Canada) or +1 (317) 833-1711 (Worldwide) Fax: +1 (855) 851-2971 Email: VISTAcare@imglobal.com Farmington, MI 48331. Executives - Robert Bosch LLC (HQ) Buy the executives list from same sector. services inc. services health. Review the reports from your clearinghouse. Timely Filing Guidelines Initial Filing - 180 calendar days of the date of service . Keeping your smile healthy is an important part of keeping your body healthy. Medica Advantage Solution HMO-POS Fact Sheet Email: connect@instamed.com, Website: . Farmington Hills, MI 48333-9085. The following are the standard claims billing requirements for providers. endstream endobj startxref Business profile of Robert Hund Inc, located at PO Box 880, Farmington, MI 48332. P.O. If you include the 2-digit suffix for the member, the claim will reject as invalid eligibility for member, InstaMed: 1-866-945-7990 Cofinity Platform Migration Fully Migrated Payers <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> You will need Adobe Reader to open PDFs on this site. 1 Campus Martius, Suite 720. Claims will no longer be rejected at Availity for a missing NPI once you have completed the enrollment process. Medica AccessAbility Solution Enhanced / Special Needs Basic Care (SNBC SNP) Better Living Now - Health Care Products, Programs and Services Contact information for corporate headquarters. Contact Us - Amerisure Postal address PO Box 4601, Carol Stream, IL 60197-4601 Farmington Hills MI 48331 United States. Phone: 1-877-268-3384. Farmington Hills, MI 48333, BIN/PCN/Group # vary by product see member's ID card, Any available provider within the Zelis network, Medica Government Programs 800-838-8957 (TTY users call 711) Claims mailing address Delta Dental PO Box 9298 Farmington Hills, MI 48333-9298. Need More Help? PO Box 550, Farmington Hills, MI 48332-0550 Telephone: 855.731.9442 (toll-free) or 317.927.6825 (7:00 am - 9:00 pm EST) Fax: 855.731.9443 Email: PCcare@imglobal.com. d `T9@w#n Ameriben Solutions Po Box 7186; Boise; ID; 83707 (800)786-7930 American Administrative Group Inc Po Box 34297; San Antonio; TX; 78265 . MI Health Link customer service. Lucent Provider Portal Please email CA.ITHelpDesk@lucenthealth.com if you have forgotten your username or need to have your password reset. Meridian follows State Medicaid guidelines for claims payment. One of our team will reach out to gather information and get you . 0 Lucent Provider Portal Dragging your feet on going digital? Cofinity (ppom) - Farmington Hill, MI Insurance Provider Box 103 Stevens Point, WI 54481 855-335-8267 www.deltadentalil.com Payer ID: WDENC Delta Dental of Indiana P.O. Box 59238 Minneapolis, MN 55459-0238 800-448-3815 deltadentalmn.org Payer #07000 1437 0 obj <> endobj Zelis - Modernizing the Healthcare Financial Experience for All PO Box 211435 State: Michigan. Health Net Claims Submissions | Health Net 4578-323-855 ( 711) . Medica Health Plan Solutions, BCBS AZ providers submit to payer ID 53589, Prior Authorization submitted via email and/or fax number provided on thecorresponding form, BIN/PCN/Group # vary by product seesee member's ID card, Claim Address (paper submission and correspondence), Zelis/Medica 100 Garden City Plaza, Suite 110Garden City, NY 11530. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Refund Overpayments (on your check stock) Allwell PO Box 3657, Carol Stream, IL 60132-3657 . The companion guides help determine the most . Delta Dental Click button below to return to the home page. Corporate Address: Delta Dental of Minnesota . Any provider within the available networks (see applicable provider fact sheet below for directory). Find a dentist, review benefits, download or print an ID card, and much more through Member Portal, available 24/7. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); The Infrastructure Investment and Jobs Act:, On June 4, 2021, the Infrastructure Investment, Amerisure Employees Continue to Put Their, In the average welding shop, youll find, Guest Blog Author: Eric Austin (Amerisure Insurance), Amerisure Receives Best Practices Award from, Farmington Hills, Mich., February 3 Amerisure. Claims Billing Requirements: 3 0 obj Learn more about claims procedures Electronic Claims Submission | Delta Dental of Michigan Date: 3/4/2023 9:53:06 PM Here are just a few good reasons to switch to electronic claims submission: You'll save money. Box 880 Farmington, MI 48331 Birmingham, AL 35266-0787 Box 2907 Milwaukee, WI 53201-2907 617-886-1234 deltadentalma.com Payer #04614 Michigan Delta Dental of Michigan P.O. . PO Box 3070 . Delta Dental 28. Ambetter from Meridian, Michigan Complete, Clearinghouse Enrollment for Atypical Providers. OneHealthPort | Organization Registration PO Box 9120 Farmington Hills, MI 48333 Phone: 1-800-448-3815. 866 0 obj <>stream Amerisure Insurance Company in Farmington Hills MI - Company Profile Electronic claims submission tips. Send an email to quotes@healthbenefitsconnect.com. MeridianComplete is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees. Meridian is currently accepting electronic claims from the following clearinghouses: IMPORTANT: Please refer to Member ID card for changes effective on April 1, 2022, as the Payer IDs are not interchangeable. Salt Lake City, UT 84130, Altru & You With Medica Note: documents in Powerpoint format (PPT) require Microsoft Viewer, download powerpoint. When a different address is used, your clearinghouse may not recognize it as a valid address for us and may not transmit your claims to us electronically. All Rights Reserved. Cofinity (ppom) Cofinity (ppom) PO Box 2720, Farmington Hill, Michigan 48333 (800) 831-1166. These plans make it easy to receive Delta Dental coverage and protect your health. You will also need to select a clearinghouse. Its quick. Corporate Address: Delta Dental of Minnesota . Contact - Delta Dental of Minnesota We're Here to Make Patient Care Simpler Welcome to the Quantum Health provider resource portal. If no email is received within 10 minutes, check that the submitted user ID is correct or contact the system administrator for additional support. PDF TPL Carrier File - azahcccs.gov Learn more about Zelis. PO Box 21993 Eagan, MN 55121 (800) 4534302 CDS AFMC CDS ADMINISTRATORS Five Gateway Center, Ste. This means that you may have to pay for some services and that you need to follow certain rules to have MeridianComplete pay for your services. You will find current eligibility and plan information and you can track claims submissions. Procedure Codes that Require X-ray or Document Submission 5. Call, Puede obtener esta informacin en otros idiomas de manera gratuita. You can get this information for free in other languages. It is important that you submit your appeal and any supporting documentation within ninety (90) days of the original claims determination. Essentia Choice Care with Medica (Individual and Family Business) university of queensland entry requirements for masters; butler county community college nursing requirements. To avoid delays, send X-rays and reports only for the procedures that require them. Please follow these guidelines for claims submission to. Check out our Online Health Insurance Quotes. The correct address for all claims, paper and electronic, for Delta Dental of Michigan, Ohio, and Indiana: Delta Dental PO Box 9085 Farmington Hills, MI 48333-9085 The rejection for a missing NPI will be received by your chosen clearinghouse and it will be their responsibility to enroll. Contact Us. Below you'll see the clearinghousesMeridian is currently accepting electronic claims from. PO Box 21342 Including a payer ID on electronic claims allows them to be routed correctly and quickly. Medica Claim Submission and Product Guidelines Select the appropriate Payer ID below to view Medica claim submission and product guidelines for each plan. endobj Ridgeview Community Network powered by Medica We are excited to announce that Cypress Benefit Administrators is now Lucent Health! PO Box 9120 Farmington Hills, MI 48333 Electronic Payer ID: 07000. Administrative Claim Appeals Allwell PO Box 3000 This Provider website delivers advanced functionality, allowing you and your staff to more easily access the information you need to facilitate treatment for our members. Telephone | 205.871.3229 bcbs mi hm710 n n/a po box 68767 grand rapids mi 49516 blue cross blue shield az 53589 n n/a .