The BlueCard Program is a national program that enables members obtaining healthcare services while traveling or living in another Blue Cross Blue Shield (BCBS) Plan’s area to receive all the same benefits of their contracting BCBS Plan and access to providers and savings. The program links participating health care providers and the independent BCBS Plans across the country and around the world through a single electronic network for claims processing and reimbursement.
Claims payment usually occurs within 30 days of the Home plan approval to pay their member’s claim.
When a member belongs to an account that is exempt from the BlueCard Program, Anthem Blue Cross and Blue Shield will electronically forward your claims to the member’s Blue Plan. That means you will no longer need to send paper claims directly to the member’s Blue Plan. Instead, you will submit these claims to Anthem Blue Cross and Blue Shield. However, you will continue to submit Medicare supplemental (Medigap) and other COB claims under your current process.
Occasionally, exceptions may arise in which Anthem Blue Cross and Blue Shield will require you to file the claim directly with the member’s Blue Plan. Here are some of those exceptions:
If you are a health care provider that 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, or telemedicine providers.
The claim submission process for international BCBS Plan members is the same as for domestic BCBS Plan members. You should submit the claim directly to Anthem Blue Cross and Blue Shield.
If you are a non-PPO (traditional) provider and are presented with an identification card with the “PPO in a suitcase” logo on it, you should still accept the card and file your claim to Anthem. You will still be given the appropriate traditional pricing per your contract with Anthem.
You should always submit BlueCard claims to Anthem Blue Cross and Blue Shield. 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. Incorrect or missing alpha prefixes and member identification numbers delay claims processing.
The BlueCard Managed Care/POS program is for members who reside outside their Blue Plan’s service area. However, unlike other BlueCard programs, BlueCard Managed Care/POS members are enrolled in Anthem Blue Cross and Blue Shield ‘s network and primary care physician (PCP) panels. BlueCard Managed Care/POS members will have a blank suitcase log on their card. Their eligibility can be verified by Anthem Blue Cross and Blue Shield as well a 1-800-676-BLUE (2583)
You can verify the member’s network benefits when you verify their eligibility. Call 1-800-676-BLUE (2583). You can also determine a member’s participation status by the logo on their ID card. A blank suitcase logo on a member’s ID card means that the patient has BCBS traditional, POS, or HMO benefits delivered through the BlueCard Program.
Some identification cards may not have an alpha prefix. This may indicate that the 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, call Anthem Blue Cross and Blue Shield’s BlueCard Customer Service Department. It is very important to capture all ID card data at the time of service. This is critical for verifying membership and coverage.
