BlueCard^® Frequently Asked Questions

Frequently asked questions and answers

• BlueCard basics
• Identifying members
• Verifying eligibility and coverage
• Pre-authorizations
• Filing claims

BlueCard basics

1. What is the BlueCard Program?
   BlueCard is a national program that enables members of one Blue Cross and/or Blue Shield Plan (Blue Plan) to obtain health care services while traveling or living in another Blue Plan's service area. The program links participating health care professionals with the independent Blue Plans across the country and in more than 200 countries and territories worldwide through a single electronic network for claims processing and reimbursement.

   The program allows you to conveniently submit claims for patients from other Blue Plans, domestic and international, to your local Blue Plan -- Regence BCBSO.

   Regence BCBSO is your contact for claims payment, problem resolution and adjustments.

2. What products are included in the BlueCard Program?
   The BlueCard Program applies to all inpatient, outpatient and professional claims. This includes traditional, Preferred Provider Organization (PPO), Point-of-Service (POS) and Health Maintenance Organization (HMO) products.
   
   
3. What benefits are excluded from the BlueCard Program?
   Dental services and prescription medication benefits are excluded from the BlueCard Program. In addition, claims for Federal Employee Program (FEP) are exempt from the BlueCard Program.
   

Identifying members

1. How do I identify members?
   When members of Blue Plans arrive in your office or facility, be sure to ask for their current member card. The card identifies BlueCard members with an alpha prefix. The member card may also have:
   • A blank suitcase logo
   • A PPO in a suitcase logo or
   • No suitcase logo
     
     
2. Why is the alpha prefix so important?
   The three-character* alpha prefix is the key element used to identify members and route out-of-area claims. The alpha prefix identifies the Blue Plan or national account to which the member belongs. It is critical for confirming a patient's membership and coverage. The remaining portion of the member number consists of seven to 14 alpha and/or numeric characters. We suggest you make copies of the front and back of the member card and share this information with your billing staff.
   
   It's important that you do not add or delete any alpha/numeric characters in the member number.
   
   *You may see member cards with a four-character alpha prefix (e.g., members of HMSA Blue Cross Blue Shield of Hawaii).
   
   
3. What are the various types of alpha prefixes?
   There are two types of alpha prefixes: plan-specific and account-specific. Plan-specific alpha prefixes are assigned to every Blue Plan and start with X, Y, Z, or Q. The first two positions indicate the Blue Plan to which the member belongs. The third position identifies the product in which the member is enrolled.
   
   
   • First character X, Y, Z or Q
   • Second character A-Z
   • Third character A-Z

   Account-specific prefixes are assigned to centrally processed national accounts. National accounts are employer groups that have offices or branches in more than one area, but offer uniform benefits coverage to all of their employees. Account-specific alpha prefixes:

   • Start with letters other than X, Y, Z, or Q.
   • Typically relate to the name of the group.
   • Use all three positions to identify the national account.
     
     
4. How do I determine a member's participation status?
   To determine the member's participation status, check the suitcase logo.
   • A blank suitcase logo on a member card indicates that the patient has traditional, POS or HMO benefits delivered through the BlueCard program.
   • A PPO in the suitcase logo indicates the patient has PPO benefits.
     
     
5. How do I identify BlueCard Managed Care/POS members?
   A blank suitcase logo on a member card means that the patient has traditional, POS or HMO benefits delivered through the BlueCard Program.
   • If members are enrolled in primary care physician (PCP) panels, the member card will include an office visit co-payment, if applicable.
     
     
6. How do I identify BlueCard PPO members?
   You'll immediately recognize the BlueCard PPO members by the special "PPO in a suitcase" logo on their member card. BlueCard PPO members are members of Blue Plans with PPO benefits, delivered through the BlueCard Program. It's important to remember that not all PPO members are BlueCard PPO members, only those whose ID cards carry this logo.
   • BlueCard PPO members traveling or living outside of their Blue Plan's service area receive the PPO level of benefits when they obtain services from designated BlueCard PPO providers or facilities.
     
     
7. What if the member card does not include an alpha prefix?
   This indicates that claims are exempt from the BlueCard Program (i.e., claims for dental and prescription medications and FEP members). Please look for instructions or a telephone number on the back of the member card.
   
   
8. What if the member card has an alpha prefix but no suitcase logo?
   If the member card has an alpha prefix (with or without a suitcase logo), send it to your local Blue Plan--Regence BCBSO. It will be paid at the member's Blue Plan's allowable. You will receive any reimbursement from your local plan.
   
   
9. How do I identify international members?
   Occasionally, you may see identification cards from international Blue Plan members. These cards will also contain three-character alpha prefixes. The claim process for international claims is the same as domestic claims. Please submit these claims to your local Blue Plan--Regence BCBSO.

Verifying eligibility and coverage

1. How do I verify membership and coverage?
   For members of other Blue Plans, you may verify membership and coverage by phone or by submitting electronic inquiries.

   Phone: Call BlueCard Eligibility at 1 (800) 676-BLUE (2583). You will be prompted for the member's alpha prefix and connected to the appropriate Blue Plan.

   Electronic inquiry: Submit an American National Standard Institute (ANSI) 270 transaction (eligibility) to Regence BCBSO. The majority of BlueCard electronic inquiries are answered within minutes.

2. What benefits and claims are exempt from the BlueCard Program?
   Dental and prescription medication benefits are exempt from the BlueCard Program. In addition, claims for the Federal Employee Program (FEP) are exempt from the program.

Pre-authorizations

1. How do I obtain pre-certifications and/or pre-authorization?
   You should remind patients from other Blue Plans that they are responsible for obtaining pre-certification/pre-authorization for their services from their Blue Plan. Note: Other Blue Plan's pre-authorization lists may differ from Regence BCBSO's.

   You may also choose to contact the member's Blue Plan on behalf of the member by phone or by submitting electronic inquiries.

   Phone-Call BlueCard Eligibility at 1 (800) 676-BLUE (2583). You will be prompted for the member's alpha prefix and connected to the appropriate Blue Plan. Ask to be transferred to the utilization review area.

   Electronic inquiry-Submit an ANSI 278 transaction (referral/authorization) to Regence BCBSO. The majority of BlueCard electronic inquiries are answered within 48-72 hours (Monday through Friday during regular office hours).

Filing claims

1. Where and how do I submit claims?
   Submit BlueCard claims electronically with your other Regence BCBSO claims or send paper claims to:

   Regence BlueCross BlueShield of Oregon
   P.O. Box 30805
   Salt Lake City, UT 84130-0805
   
   Be sure to include the member's complete number when you submit the claim. The complete number includes the three-character alpha prefix. Incorrect or missing alpha prefixes and numbers delay claims processing. Do not send duplicate claims.

2. How do I submit international claims?
   The claim submission process for international Blue Plan members is the same as for domestic Blue Plan members. You should submit the claim directly to Regence BCBSO.
   
   
3. How do I submit claims if I'm an indirect, support or remote provider?
   If you are a health care professional 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 limited to:
   • Prosthesis manufacturers
   • Durable medical equipment suppliers
   • Independent or chain laboratories or
   • Telemedicine providers
   
   If you are an indirect, support or remote provider for members from multiple Blue Plans, follow these claim-filing procedures:
   • If you have a contract with the member's Blue 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 Blue Plan, file with your local Blue Plan--Regence BCBSO.
   
   
   
4. What are the exceptions to BlueCard claims submissions?
   Submit claims directly to the member's Blue Plan instead of Regence BCBSO in the following situations:
   • You contract with the member's Blue Plan.
   • The member card does not include an alpha prefix.
   • The benefits are excluded from the BlueCard Program (e.g., dental and prescription medications).
   • The member belongs to the Federal Employee Program (FEP) - please follow your FEP guidelines. When in doubt, please submit the claim to us electronically or send the paper claim to us at:

Regence BlueCross BlueShield of Oregon
P.O. Box 30805
Salt Lake City, UT 84130-0805

Note: Occasionally you may be asked to submit BlueCard claims directly to the member's Blue Plan. For instance, there may be a temporary processing issue at Regence BCBSO or the member's Blue Plan or both that prevents completion of claims through the BlueCard Program

5. How do I handle Coordination of Benefit (COB) claims?
   Coordination of Benefits (COB) refers to the prevention of double payment for services when a member has coverage from two or more payers. The member's contract language explains which payer has primary responsibility for payment. Please follow the procedures below for submitting COB claims.
   • Member has coverage with two out-of-area Blue Plans
     • Send the claim to Regence BCBSO with the primary member number first.
     • After you receive the Explanation of Benefits (EOB), send the information with a new bill to Regence BCBSO for secondary payment. The claim will not automatically crossover.
   • Another carrier is the primary payer and a Blue Plan is secondary
     • Bill the other carrier first.
     • Send the EOB from the other carrier with the claim to Regence BCBSO for secondary payment. The claim will not automatically crossover.
       
     
     
6. How will I receive payment?

1. Once Regence BCBSO receives a claim, we will price the claim based on your contract with us (participating or preferred) and electronically route the claim to the member's Blue Plan.
2. The member's Blue Plan adjudicates the claim and approves payment based on the member's benefits:
   
   • Member card has an empty suitcase logo. The member has traditional, point of service (POS) or Health Maintenance Organization (HMO) benefits and you will be reimbursed at participating provider rates.
   • Member card has a PPO in the suitcase logo. The member has Preferred Provider Organization (PPO) level of benefits when they obtain services from a physician or hospital designated as a BlueCard PPO provider. If you are a BlueCard PPO provider, you will be reimbursed at preferred provider rates. Regence BCBSO Preferred Provider Plan (PPP) providers are considered BlueCard PPO providers. To find out if you're a BlueCard PPO provider, visit www.bcbs.com. It's important to note that not all PPO members are BlueCard PPO members, only members whose ID cards carry this logo. If you are not a PPO provider, you will receive participating provider rates.
3. Regence BCBSO will reimburse you accordingly and provide information on your payment voucher.
   

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