Section 2 - What is the BlueCard Program?
BlueCard® is a national program that enables members of one Blue Plan to obtain health care services while traveling or living in another Blue Plan’s service area. The program links participating health care providers with 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 submit claims for patients from other Blue Plans, domestic and international, to your local Blue Plan.
Your local Blue Plan is your sole contact for claims payment, problem resolution and adjustments.
BlueCard® Program Advantages to Providers
The BlueCard® Program allows you to conveniently submit claims for members from other Blue Plans, including international Blue Plans, directly to Blue Cross and Blue Shield of Nebraska (BCBSNE).
BCBSNE will be your one point of contact for all of your claims-related questions.
BCBSNE continues to experience growth in out-of-area membership because of our partnership with you. That is why we are committed to meeting your needs and expectations. In doing so, your patients will have a positive experience with each visit.
Products Included in BlueCard
A variety of products and claim types are eligible to be delivered via BlueCard; however, not all Blue Plans offer all of these products to their members:
- Traditional (Indemnity insurance)
- PPO (Preferred Provider Organization)
- EPO (Exclusive Provider Organization)
- POS (Point of Service)
- HMO (Health Maintenance Organization)
- Medicaid (Payment is limited to the member’s Plan’s state Medicaid reimbursement rates.) These cards will not have a suitcase logo.
SCHIP (State Children’s Health Insurance Plan) if administered as part of Medicaid: payment is limited to the member’s Plan’s state Medicaid reimbursement rates. These member ID cards also do not have a suitcase logo.
Stand-alone SCHIP programs will have a suitcase logo.
Stand-alone vision Stand-alone prescription drugs 14 Return to Start of Section Proceed to Next Section Go to Table of Contents
Note: Stand-alone vision and stand- alone self-administered prescription drugs programs are eligible to be processed through BlueCard when such products are not delivered using a vendor. Refer to the claim filing instructions on the back of the ID cards.
Products Excluded from the BlueCard Program
The following claims are excluded from the BlueCard Program:
- Stand-alone dental
- Medicare Advantage
- The Federal Employee Program (FEP)
How does the BlueCard® Program work?
How to Identify Members
When a member of a Blue Plan arrives at your office or facility, be sure to ask them for their current Blue Plan membership identification (ID) card.
The main identifier for out-of-area members is the alpha prefix. The ID cards also may have:
PPO in a suitcase logo, for eligible PPO members
Blank suitcase logo
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. It is always located at the beginning of the member’s ID number.
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 Plan.
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 Plan or National Account to which the member belongs. It is critical for confirming a patient’s membership and coverage.