Common use of Telephone Numbers Clause in Contracts

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 0000 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9420 0000 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 MN 55121 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 MN 55121 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: •  Monday thru Friday 8:00 AM to 8:00 PM •  Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 0000 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9420 0000 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: •  Monday thru Friday 8:00 AM to 8:00 PM •  Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 01-000800-000639-00002227; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 01-000800-000639-00002227; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 0000 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 MN 55121 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9420 0000 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 0000 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9420 0000 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: •  Monday thru Friday 8:00 AM to 8:00 PM •  Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 0000 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 MN 55121 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9420 0000 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: •  Monday thru Friday 8:00 AM to 8:00 PM •  Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 01-000800-000639-00002227; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 01-000800-000639-00002227; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 0000 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 HarrisburgX.X. Xxx 00000 Xxxxxxxxxx, PA 17106XX 00000-9420 0000 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

Telephone Numbers. Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Prime Mail Order): 0- : 0-000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh ValleyX.X. Xxx 00000 Xxxxxx Xxxxxx, PA 18002XX 00000-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 0000 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 MasonX.X. Xxx 0000 Xxxxx, OH 45040XX 00000-7111 0000 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: •  Monday thru Friday 8:00 AM to 8:00 PM •  Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours. BlueCard Access To locate a provider outside of Rhode Island call 0-000-000-XXXX (2583) or use the “Find A Doctor” feature on our website.