Frequently Asked Questions - BlueCard Program

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:

• You contract with the member’s Blue Plan (for example, in contiguous county or overlapping service area situations).
• The ID card does not include an alpha prefix.

Occasionally, Anthem may request that you file the claim directly with the member’s plan. For instance, there may be a temporary processing issue at Anthem, the member’s plan, or both that prevents completion of the claim through the BlueCard Program. When in doubt, please send the claim to Anthem and we will handle the claim for you.

• If you have a contract with the member’s Plan, file with that Plan.
• If you normally send claims to the direct provider of care, follow 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 Plan, file with Anthem Blue Cross and Blue Shield.

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.

Once Anthem Blue Cross and Blue Shield receives a claim, it will electronically route the claim to the member’s BCBS Plan. The member’s Plan then processes the claim and approves payment, and Anthem Blue Cross and Blue Shield will pay you.

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.

You’ll immediately recognize BlueCard PPO members by the special “PPO in a suitcase” logo on their membership card. BlueCard PPO members are BCBS members whose PPO benefits are delivered through the BlueCard Program. It is important to remember that not all PPO members are BlueCard PPO members, only those whose membership cards carry this logo. BlueCard PPO members traveling or living outside of their Blue Plan’s area receive the PPO level of benefits when they obtain services from designated BlueCard PPO providers.

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. We suggest that you make copies of the front and back of the ID card and pass this key information on to your billing staff. Do not make up alpha prefixes.

There are two types of alpha prefixes: Plan-specific and account-specific. 

The three-character alpha prefix at the beginning of the member’s identification number is the key element used to identify and correctly route out-of-area claims. The alpha prefix identifies the BCBS Plan or national account to which the member belongs. It is critical for confirming a patient’s membership and coverage. The prefix is part of the member’s identification number.

When members from other BCBS Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership identification card. The main identifiers for BlueCard members are the alpha prefix, a blank suitcase logo, and, for eligible PPO members, the “PPO in a suitcase” logo. (Members from other Blue Cross and Blue Shield plan’s, other than Anthem, are generally considered BlueCard members)

Occasionally, BCBS HMO members affiliated with other BCBS Plans will seek care at your office or facility. You should handle claims for these members the same way as you do Anthem Blue Cross and Blue Shield members and BCBS traditional, PPO and POS patients from other Blue Plans¾by submitting them to Anthem through the BlueCard Program.

Similar to BlueCard Traditional and BlueCard PPO, the BlueCard Managed Care/POS program is for members who reside outside their Blue Cross Blue Shield Plan’s service area. However, unlike other BlueCard programs, BlueCard Managed Care/POS members are actually enrolled in the (name of local Plan) network and primary care physician (PCP) panels. Therefore, you should treat these members as you treat any other Anthem Blue Cross and Blue Shield POS member, applying the same referral practices and network protocols.

A national program that offers members traveling or living outside of their Blue Plan’s area the PPO level of benefits when they obtain services from a physician or hospital designated as a BlueCard PPO provider.

A national program that offers members traveling or living outside of their Blue Plan’s area the traditional, or indemnity level of benefits when they obtain services from a physician or hospital outside of their Blue Plan’s service area.

Medicare+Choice is excluded from the BlueCard Program. You must file Medicare+Choice claims with the member’s BCBS Plan. In addition, claims for the Federal Employee Program (FEP) are exempt from the BlueCard Program. Please follow your FEP billing guidelines

Currently four types of products are administered through the BlueCard Program: BlueCard Traditional, BlueCard PPO, BlueCard Managed Care/POS, and HMO. The following products are optional under the BlueCard Program.

• Stand-alone dental and prescription drugs
• Stand-alone vision and hearing

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.