How Does the BlueCard Program Work
How to Identify Members
1. Member ID Cards
When members of Blue Cross and/or Blue Shield Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card.
The main identifier for out of area members is the alpha prefix. The ID cards may also have:
| PPO in a suitcase logo, for eligible PPO members|
| Blank suitcase logo|
| No suitcase|
Important facts concerning member IDs:
| A correct member ID number includes the alpha prefix (first three positions) and all subsequent characters, up to 17 positions total.|
| The alpha prefix on a member’s ID must be three characters.|
| Some member ID numbers may include alphabetic characters in other positions following the alpha prefix. Others may be fewer than 17 positions. |
| Do not add/delete characters or numbers within the member ID.|
| Do not change the sequence of the characters following the alpha prefix.|
| The alpha prefix is critical for the electronic routing of specific HIPAA transactions to the appropriate Blue Cross and/or Blue Shield Plan.|
| Members who are part of the Federal Employee Program (FEP) will have the letter "R" in front of their member ID number. Claims for these members should also be filed with the local/Host Plan.|
a. Alpha Prefix
The three-character alpha prefix, at the beginning of the member’s identification 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 critical for confirming a patient’s membership and coverage.
To ensure accurate claim processing, it is critical to capture all ID card data. If the information is not captured correctly, you may experience a delay with the claim processing. Please make copies of the front and back of the ID card, and pass this key information to your billing staff. Do not make up alpha prefixes.
Do not assume that the member’s ID number is the social security number. Use of the social security number on ID cards will be phased out by January 1, 2006.
b. Sample ID Cards
c. How to Identify International Members
Occasionally, you may see identification cards from foreign BC and/or BS Plan members. These ID cards will also contain three-character alpha prefixes. Please treat these members the same as domestic BC and/or BS Plan members. See sample ID card below:
Front and back of sample international ID card
2. Membership, Coverage, and Eligibility for Members
For local Anthem Blue Cross and Blue Shield (Maine) members, contact Provider Service at 1-800-832-6011 or 207-822-8181.
For other Blue Plans members, contact BlueCard Eligibility® by phone or Anthem Blue Cross and Blue Shield electronically to verify the patient’s eligibility and coverage:
Phone - Call 1-800-676-BLUE (2583)
| English and Spanish speaking phone operators are available to assist you.|
| 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 Blue Cross and Blue Shield. You may be transferred to a voice response system linked to customer enrollment and benefits or you may need to call back at a later time.|
| The BlueCard® Eligibility line is for eligibility, benefit and pre-certification/referral authorization inquiries only. It should not be used for claim status. See Claim Filing section for claim filing information.|
Electronic - Submit a HIPAA 270 transaction (eligibility) to Anthem Blue Cross and Blue Shield.
3. Utilization Review
You should remind patients that they are responsible for obtaining pre-certification/ preauthorization for their services from their Blue Cross and/or Blue Shield Plans.
You may also contact the member’s Plan on the member’s behalf.
| For Anthem Blue Cross and Blue Shield members:|
Phone - Call 1-800-392-1016
| For other Blue Plans members:|
Phone - Call 1-800-676-BLUE (2583) - ask to be transferred to the utilization review area.
Electronic - Submit a HIPAA 278 transaction (referral/authorization) to Anthem Blue Cross and Blue Shield.
4. Claim Filing
| You should submit all claims to:|
Anthem Blue Cross and Blue Shield
P.O. Box 533
North Haven, CT 06473
Be sure to include the member’s complete identification number when you submit the claim. The complete identification number includes the three-character alpha prefix—do not make up alpha prefixes. Claims with incorrect or missing alpha prefixes and member identification numbers cannot be filed correctly.
| In cases where there is more than one payer and Blue Cross and/or Blue Shield is a primary payer, submit other party liability (OPL) information with the Blue Cross and/or Blue Shield claim. Upon receipt, Anthem Blue Cross and Blue Shield will electronically route the claim to the member’s Blue Plan. The member’s Plan then processes the claim and approves payment; Anthem Blue Cross and Blue Shield will pay you.|
| Do not send duplicate claims. To check claim status, contact Anthem Blue Cross and Blue Shield at 1-877-795-1881 or submit an electronic HIPAA 276 transaction (claim status request) to Anthem Blue Cross and Blue Shield.|
a. Medicare-Related Claims
1. The following are guidelines for processing of Medicare-related claims:
When Medicare is primary payor, submit claims to your local Medicare intermediary. After you receive the Explanation of Medicare Benefits (EOMB) from Medicare, review the indicators:
| If the indicator on the EOMB shows that the claim was crossed-over, Medicare has submitted the claim to the appropriate Blue Plan and the claim is in progress. You can make claim status inquiries for supplemental claims through Anthem Blue Cross and Blue Shield. |
| If you have any questions regarding the crossover indicator, please contact the Medicare intermediary.|
2. Do not submit Medicare-related claims to your local Blue Plan before receiving an EOMB from the Medicare intermediary.
3. If you use other carrier name and address (OCNA) number on a Medicare claim, ensure it is the correct for the member’s Blue Plan. Do not automatically use the OCNA number for Anthem Blue Cross and Blue Shield or create an OCNA number of your own. In addition, do not create alpha prefixes. For an electronic HIPAA 835 (Remittance Advice) request on Medicare-related claims, contact Anthem Blue Cross and Blue Shield.
4. Do not send duplicate claims. First check a claim’s status by contacting Anthem Blue Cross and Blue Shield by phone or through an electronic HIPAA 276 transaction (claim status request).
Below is an example of how claims flow through BlueCard
b. International Claims
The claim submission process for international Blue Cross and/or Blue Shield Plan members is the same as for domestic Blue Cross and/or Blue Shield members. You should submit the claim directly to Anthem Blue Cross and Blue Shield.
Code claims as you would for Anthem Blue Cross and Blue Shield claims.
d. Medical Records
There are times when the member’s Blue Cross and/or Blue Shield Plan will require medical records to review the claim. These requests should come from Anthem Blue Cross and Blue Shield. Please forward all requested medical records to Anthem Blue Cross and Blue Shield and we will coordinate with the member’s Blue Cross and/or Blue Shield Plan. Please direct any questions or inquiries regarding medical records to the BlueCard Call Center at 1-877-795-1881 or fax to 207-822-5800.
Contact Anthem Blue Cross and Blue Shield if an adjustment is required. We will work with the member’s BC and/or BS Plan for adjustments; however, your workflow should not be different.
1. Appeals for all claims are handled through Anthem Blue Cross and Blue Shield.
2. We will coordinate the appeal process with the member’s Blue Cross and/or Blue Shield Plan, if needed.
g. Coordination of Benefits (COB) Claims
1. Coordination of benefits (COB) refers to how we ensure members receive full benefits and prevent double payment for services when a member has coverage from two or more sources. The member’s contract language explains the order for which entity has primary responsibility for payment and which entity has secondary responsibility for payment.
2. If after calling 1-800-676-BLUE (2583) or through other means you discover the member’s benefit plan has a COB provision, and Anthem Blue Cross and Blue Shield is the primary payer, submit the claim with information regarding COB to Anthem Blue Cross and Blue Shield. If you do not include the COB information with the claim, the member’s Blue Plan or the insurance carrier will have to investigate the claim. This investigation could delay your payment or result in a post-payment adjustment.
h. Claim Payment
1. If you have not received payment for a claim, do not resubmit the claim because it will
be denied as a duplicate. This also causes member confusion because of multiple Explanations of Benefits (EOBs).
2. If you do not receive your payment or a response regarding your payment, please call Anthem Blue Cross and Blue Shield at 1-877-795-1881or visit our Web site at www.anthem.com to check the status of your claim.
3. In some cases, a member’s Blue Plan may suspend a claim because medical review or additional information is necessary. When resolution of claim suspensions requires additional information from you, Anthem Blue Cross and Blue Shield may either ask you for the information or give the member’s Plan permission to contact you directly.
i. Claim Status Inquiry
1. Anthem Blue Cross and Blue Shield is your single point of contact for all claim inquiries.
2. Claim status inquires can be done by:
Phone – Call 1-877-795-1881 from 8:30 a.m. - 5:00 p.m. or
Electronically – Send a HIPAA transaction 276 (claim status inquiry) to Anthem Blue Cross and Blue Shield.
j. Calls from Members and Others with Claim Questions
1. If members contact you, advise them to contact their BC and/or BS Plan and refer them to their ID cards for customer service numbers.
2. The member’s Plan should not contact you directly, but if the member’s Plan contacts you and asks you to submit the claim to them, refer them to Anthem Blue Cross and Blue Shield.
5. Key Contacts
Where to Find More Information
For more information, call Anthem Blue Cross and Blue Shield at 1-877-795-1881 or visit the Anthem Blue Cross and Blue Shield Web site at www.anthem.com.