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BlueCard section

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Subsections:
What is the BlueCard Program?
Definition 
BlueCard is a national program that enables members obtaining health care services while traveling or living in another Blue Cross and/or Blue Shield plan’s area to receive all the benefits of their contracting Blue Cross and/or Blue Shield Plan. The program also gives members access to BlueCard Providers across the country and around the world, providing them with health care cost savings. The program links participating health care Providers and the independent Blue Cross and Blue Shield plans across the country and around the world through a single electronic network for claims processing and reimbursement. 
BlueCard Program Advantages 
The BlueCard program allows Providers to submit claims for members who are enrolled through other Blue Cross and/or Blue Shield plans, including international Blue Cross and Blue Shield plans, directly to Anthem. Anthem is your one point of contact for most claims-related questions. Providers also have access to the BlueCard Eligibility phone line to obtain information on patient eligibility and coverage (see the Telephone/Address Directory section for the phone number). In most cases for all BlueCard claims, Providers will receive payment from Anthem, rather than from members or other Blue Cross and/or Blue Shield plans. 
Claims and Products Included in the BlueCard® Program 
The BlueCard program applies to all inpatient, outpatient and professional claims.  
PPO, HMO, Managed Care/POS Traditional and BlueCard WorldWide products are included in the BlueCard program. The following products are optional under the BlueCard program: 
Stand-alone dental and prescription drugs
Stand-alone vision and hearing coverage
Medicare Supplement coverage
 
Accounts Exempt from the BlueCard Program 
Claims for the Federal Employee Health Benefit Program (FEHBP) Service Benefit Plan are exempt from the BlueCard program. Please follow your FEHBP billing guidelines. 
 
 
What Products Are Included in the BlueCard Program
Background 
Four types of products are currently administered through the BlueCard program: BlueCard Traditional, BlueCard PPO, BlueCard Managed Care/POS and HMO. 
BlueCard Traditional  
This is a national program that offers members traveling or living outside their Blue Cross and/or Blue Shield plan’s area the Traditional, or Indemnity, level of benefits when they obtain services from a contracted physician or hospital outside their Blue Cross and/or Blue Shield plan’s service area. 
BlueCard PPO  
This is a national program that offers members traveling or living outside their Blue Cross and/or Blue Shield plan’s area the PPO level of benefits when they obtain services from a contracted physician or hospital designated as a BlueCard® PPO Provider. 
BlueCard Managed Care/POS  
Similar to BlueCard Traditional and BlueCard PPO, the BlueCard Managed Care/POS program is for members who reside outside their Blue Cross and/or Blue Shield plan’s service area. However, unlike other BlueCard programs, BlueCard Managed Care/POS members are enrolled in the Anthem network and use PPO primary care physician (PCP) panels. Therefore, apply the same referral practices, authorization procedures and network protocols for these members as you do for other Anthem PPO members. 
HMO Patients Serviced Through the BlueCard Program  
Blue Cross and/or Blue Shield HMO members affiliated with other Blue Cross and/or Blue Shield plans may seek care at your office or facility for urgent, emergent or pre-certified follow-up care. Handle claims for these members the same way you do for Anthem members and for Blue Cross and Blue Shield Traditional, PPO and POS patients from other Blue Cross and/or Blue Shield plans by submitting them to Anthem. 
BlueCard® WorldWide  
International Blue Cross and Blue Shield plan members are easy to recognize because their member ID cards include the Blue Cross and Blue Shield names and marks. The cards also include a three-character alpha prefix at the beginning of the members’ ID number. The alpha prefix is key to identifying the member’s Blue Cross and Blue Shield plan and facilitating payment. The member ID cards of international Blue Cross and Blue Shield plan members may look different than what you are accustomed to seeing. 
Here is an example of a health plan ID card for a member from Italy:  

 
 
How Does The BlueCard Program Work?
How to Identify BlueCard® Members 
When members from other Blue Cross and Blue Shield plans arrive at your office or facility, ask them for their current Blue Cross and/or Blue Shield plan member ID card. In addition to the Blue Cross and/or Blue Shield brand marks, the identifiers for BlueCard (Traditional, HMO and POS) members are the alpha prefix and a blank suitcase logo, and for BlueCard PPO members the identifiers are the alpha prefix and the “PPO in a suitcase” logo. 
Alpha Prefix 
The three-character alpha prefix at the beginning of the member’s ID number is the key element used to identify and correctly route claims. The alpha prefix identifies the Blue Cross and/or Blue Shield plan or national account to which the member belongs. It is also critical for confirming a patient’s membership and coverage.  
The alpha prefix always contains alpha characters, such as GCO, and never numeric characters. The last character is the letter O and never the number zero. Some member ID numbers contain alpha characters. These alpha characters are part of the member’s ID number and must be submitted along with the alpha prefix. For example Jane Doe’s Blue Cross and Blue Shield ID card contains the following member ID number: ABCD123456. The alpha prefix for this ID is ABC. The member ID number is D123456. Always submit both the alpha prefix and the member ID number exactly as shown on the member’s ID card. 
Member ID cards with no alpha prefix: Some ID cards may not have an alpha prefix. This may indicate that the member ID card is old or that claims are handled outside the BlueCard program. Please look for instructions or a telephone number on the back of the member’s ID card for how to file these claims. If that information is not available, please call Anthem. 
It’s important to capture all member ID card data at the time of service. This is critical for verifying membership and coverage. We suggest that you make copies of the front and back of the member ID card and pass this key information on to your billing staff. Do not make up alpha prefixes. Always ask members for their most current member ID card. 
Due to HIPAA legislation and Blue Cross and Blue Shield Association mandates, all Blue Cross and/or Blue Shield plans have issued member ID cards that no longer contain the member’s Social Security number as part of their ID number. ID numbers include a three-character alpha prefix followed by up to 14 additional alpha-numeric characters. Please submit claims using the member’s current ID number as it appears on the member’s ID card. 
Blank Suitcase Logo 
A blank suitcase logo on a member’s ID card means the patient has Blue Cross and Blue Shield Traditional, POS or HMO benefits delivered through the BlueCard program. 

The blank suitcase logo may appear anywhere on the front of the ID card. 
The easy-to-find alpha prefix identifies the member’s Blue Cross and Blue Shield Plan. 
“PPO in a Suitcase” Logo 
You will immediately recognize BlueCard PPO members by the special “PPO in a suitcase” logo on their member ID card. BlueCard PPO members are Blue Cross and Blue Shield members whose PPO benefits are delivered through the BlueCard program. Not all PPO members are BlueCard PPO members, only those whose member ID cards carry this logo. BlueCard PPO members traveling or living outside their Blue Cross and/or Blue Shield plan’s area receive the PPO level of benefits when they obtain services from designated BlueCard PPO Providers. 

The “PPO in a suitcase” logo may appear anywhere on the front of the card. 
How to Identify BlueCard® Managed Care/POS Members  
The BlueCard Managed Care/POS program is for members who reside outside their Blue Cross and/or Blue Shield plan’s service area. However, unlike other BlueCard programs, BlueCard Managed Care/POS members are enrolled in the Anthem network and use Anthem’s PPO primary care physician (PCP) panels. You can recognize BlueCard Managed Care/POS members who are enrolled in the POS network through the member ID card as you do for all other BlueCard members. The member ID cards will include a local network identifier (POS network) and the three-character alpha prefix preceding the member’s ID number. The POS member ID card also includes the blank suitcase logo. 

How to Identify International Members  
Occasionally, you may see member ID cards from Blue Cross and Blue Shield plan members from outside the United States. These member ID cards will also contain three-character alpha prefixes. Please follow the same guidelines for these members as for domestic Blue Cross and/or Blue Shield Plan members. This includes calling the BlueCard Eligibility line (see the Telephone/Address Directory section) to verify eligibility and coverage information. 
International Blue Cross and Blue Shield members enrolled in accounts such as RAS/Cliniservice (Italy) and Vereinte (Germany) have alpha prefixes ZZC and ZZD respectively. When you see member ID cards with these alpha prefixes or any other alpha prefix, please call BlueCard Eligibility (see Telephone/Address Directory section) for eligibility and coverage information. Operators are available to help you weekdays during regular business hours. The operator will ask for the alpha prefix shown on the member’s ID card. International members may not have coverage for non-emergency outpatient or physician services. In these instances, please collect payment from the member at the time of service. 
Please follow the steps below for international Blue Cross and Blue Shield plan members: 
With the patient’s ID card in hand, call BlueCard Eligibility (see Telephone/Address Directory section). An operator will ask you for the three-character alpha prefix.
File the claim with Anthem.
Please be sure to collect payment for non-covered services.
 
How to Verify Membership and Coverage 
Currently, there are two methods for verifying member eligibility and coverage. 
You may access Provider Self Service
Call the BlueCard Eligibility line toll free at 800-676-BLUE (2583). Please have the member’s ID card available when calling.
 
BlueCard Eligibility operators are available to help you weekdays during regular business hours (7 a.m.-10 p.m. EST). They will ask for the alpha prefix shown on the member’s ID card and will connect you directly to the appropriate membership and coverage unit at the member’s Blue Cross and/or Blue Shield plan. If you call after hours, you will get a recorded message stating the business hours. 
Keep in mind that Blue Cross and/or Blue Shield plans are located throughout the country and may operate on a different time schedule than Anthem. It is possible you will be transferred to a voice response system linked to customer enrollment and benefits, or you may need to call back at a later time. 
How to Obtain Precertification/Preauthorization 
You should remind patients who are PPO and Traditional members from other Blue Cross and/or Blue Shield plans that they are responsible for obtaining pre-certification for their services from their Blue Cross and/or Blue Shield plan. You may call the BlueCard Eligibility line (see Telephone/Address Directory section), or call the pre-certification/pre-authorization number on the back of the member’s ID card on behalf of the member. The operator will ask for the member’s alpha prefix. 
Where and How to Submit BlueCard Program Claims 
Always submit BlueCard claims to Anthem (please see the Telephone/Address section for the claims filing address). Be sure to include the member’s complete ID number when submitting the claim. The complete ID number includes the three-character alpha prefix. Please note some member ID numbers may contain additional alpha characters. These additional alpha characters are part of the member’s ID number and must be submitted along with the alpha prefix. Do not make up alpha prefixes or change the member’s ID number in any way. Incorrect or missing alpha prefixes and member ID numbers delay claims processing. 
Once Anthem receives a claim, it will be routed to the member’s Blue Cross and/or Blue Shield plan. The member’s plan then processes the claim and approves payment, and in most cases Anthem will pay you. 
If you are a non-PPO (Traditional) provider and are presented with a member ID card with the “PPO in a suitcase” logo on it, you should still accept the card and file your claims with Anthem. You will still be reimbursed the appropriate Traditional pricing.  
International Claims 
The claim submission process for international Blue Cross and Blue Shield plan members is the same as for domestic Blue Cross and/or Blue Shield plan members. Please submit claims directly to Anthem. In addition, for claims related to members from Italy, please send hard copies of the claim and medical records to: 
World Access
Attn: International Claims
6600 W Broad St.
Richmond, VA 23230 
Indirect, Support or Remote Providers 
If you are Provider who offers products, materials, informational reports, and remote analyses or services and are not present in the same physical location as a patient, you are considered an indirect, support or remote Provider. Examples include, but are not limited to, prosthesis manufacturers, durable medical equipment suppliers, independent or chain laboratories, and telemedicine Providers.  
If you are an indirect Provider for members from multiple Blue Cross and/or Blue Shield plans, please follow these claim filing rules: 
If you have a contract with the member’s Blue Cross and/or Blue Shield plan, file claims with that plan.
If you normally send claims to the direct Provider of care, follow you normal procedures.
If you do not normally send claims to the direct Provider of care and you do not have a contract with the member’s Blue Cross and/or Blue Shield plan, file claims with Anthem.
 
Exceptions to BlueCard Claims Submissions 
Occasionally, exceptions may arise for which Anthem will require you to file the claim directly with the member’s Blue Cross and/or Blue Shield plan. Those exceptions include the following situations: 
You contract with the member’s Blue Cross and or Blue Shield plan (for example, in contiguous county or overlapping service area situations).
The member ID card does not include an alpha prefix.
 
When in doubt, please send the claim to Anthem. 
Claims for Accounts Exempt from the BlueCard Program 
When a member belongs to an account that is exempt from the BlueCard program, but the member’s ID number includes an alpha prefix, Anthem will forward your claims electronically to the member’s Blue Cross and/or Blue Shield plan. That means you do not need to send paper claims directly to the member’s Blue Cross and/or Blue Shield plan. Instead, you will submit these claims to Anthem.  
Coordination of Benefits (COB) Claims 
Coordination of benefits (COB) refers to the process for members receiving full benefits while preventing double payment for services when a member has coverage from two or more sources. The member’s contract outlines which entity has primary responsibility for payment and which entity has secondary responsibility for payment. 
If after calling the BlueCard Eligibility line (see the Telephone/Address Directory section) or through other means you discover that the member’s plan contains a COB provision, and a Blue Cross and/or Blue Shield plan or another insurance carrier is the primary payer, submit the claim along with information regarding COB to Anthem or the other insurance carrier. If you do not include the COB information with the claim, the member’s Blue Cross and/or Blue Shield plan or the other insurance carrier will have to investigate the claim. This investigation could delay your payment or result in a post-payment adjustment, which will increase your volume of bookkeeping. 
Medicare Supplement Claims 
For Medicare Supplement claims, always file with the Medicare contractor first. Always include the complete health insurance claim number (HICN); the patient’s complete Blue Cross and/or Blue Shield plan member ID number, including the three-character alpha prefix; and the Blue Cross and/or Blue Shield plan name as it appears on the patient’s member ID card, for supplemental insurance. This will help ensure crossover claims are forwarded appropriately.  
Do not file with Anthem and Medicare simultaneously. Wait until you receive the explanation of medical b enefits (EOMB) or payment advice from Medicare. After you receive the Medicare EOMB/payment advice, determine if the claim was automatically crossed over to the supplemental insurer. 
Crossover Claims: If the claim was crossed over, the EOMB/payment advice should typically have remark code MA 18 printed on it, which states: “The claim information is also being forwarded to the patient’s supplemental insurer.” The code and message may differ if the contractor does not use the ANSI X12 835 payment advice. If the claim was crossed over, do not file for the Medicare Supplement benefits. The Medicare Supplement insurer will automatically pay you if you accepted Medicare assignment. Otherwise, the member will be paid and you must bill the member. Some plans do not have the capability to receive the Provider information attached with Medicare crossover claims; therefore, these plans may forward payments to the member instead of to the Provider. In such cases, it is appropriate for the Provider to collect member cost shares from the member. 
Claims Not Crossed Over: If the EOMB/payment advice does not indicate the claim was crossed over and you accepted Medicare assignment, file the claim as you do today. Anthem or the member’s Blue Cross and/or Blue Shield plan will pay you the Medicare Supplement benefits. If you did not accept assignment, the member will be paid and you must bill the member. 
Payment for BlueCard Claims 
Timing for claims processing may vary at each Blue Cross and/or Blue Shield plan. If you have not received payment, please do not resubmit the claim. If you resubmit the claim, it will be denied as a duplicate. You may also confuse the member because he or she will receive another EOB and may call customer service. 
In some cases, a member’s Blue Cross and/or Blue Shield plan may suspend a claim because medical review or additional information is necessary. When resolution of claim suspensions requires additional information from you, Anthem may ask you for the information or give the member’s plan permission to contact you directly. 
Claims Status, Adjusting BlueCard Claims and Resolving Other Issues 
Please follow the same steps as for any claim inquiry, which are as follows: 
Access the electronic transaction reports if you transmit claims through EDI, EMC NET, Connect:Mailbox or NDM.
To request a claim adjustment, please follow the standard claim adjustment filing procedures.
To inquire about claim status, please see the customer service numbers in the Telephone/Address Directory section.
 
How to Handle Calls from Members and Others Claims Questions 
If members contact you, please ask them to contact their Blue Cross and/or Blue Shield plan. Refer them to the front or back of their member ID card for a customer service phone number. The member’s Blue Cross and/or Blue Shield plan should not contact you directly, unless you have received an explanation of payment (EOP) from Anthem stating the claim is handled directly with the member’s Blue Cross and/or Blue Shield plan. 
Who to Contact for Claims Questions 
Please call the customer service phone numbers in the Telephone/Address Directory section.  
Where to Find More Information about the BlueCard Program 
For more information about the BlueCard program, please call the BlueCard customer service phone numbers in the Telephone/Address Directory section, or the Blue Cross and Blue Shield Association’s website at www.bcbs.com. 
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use