| The BlueCard®
Program links participating health care providers
and independent Blue Cross and Blue Shield Plans
(Blue Plans) across the country through a single
electronic network for claims processing and reimbursement.
Please feel free to send us any comments or suggestions
on how you feel this web site could be even more
helpful to you and your colleagues.
Advantages for you
The program allows you to submit claims for patients
from other Blue Plans directly to your local Blue
Plan --Regence BlueShield.
- All claims for out-of-area Blue Plan members
with alpha prefixes on their identification
(ID) cards should be submitted to Regence BlueShield
unless you are a participating provider with
the member’s Blue Plan, in which case
the claim should be submitted directly to that
plan.
- BlueCard claims can be submitted electronically
or manually and must include the member's complete
ID number (including the three-character alpha
prefix) from the member’s ID card.
Regence BlueShield will be your primary contact for
BlueCard claims submission, payment, adjustments,
and inquiries.
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Identifying BlueCard Members
Always ask members for their current Blue Plan member
ID card. The two main identifiers for BlueCard members
are the alpha prefix and suitcase logo.
Alpha Prefix
The three-character alpha prefix on the member’s
ID card is the key element used to identify and correctly
route out-of-area claims. The alpha prefix identifies
the member’s Blue Plan or national account. There
are two types of alpha prefixes, plan-specific and account-specific.
Plan-specific alpha prefixes are
assigned to every Plan and start with X, Y, Z or Q.
The first two positions indicate the Blue Plan the
member belongs to, while the third position identifies
the product the member is enrolled in.
- 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
coverage benefits to all 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.
No alpha prefix: Some member's ID
cards do not have an alpha prefix. This may indicate
that claims are handled outside the BlueCard®
Program. Refer to the back of the member's ID card
for instructions on where to file claims for these
members.
Suitcase logo
In addition to the alpha prefix, member ID cards may
also have:
PPO in a Suitcase Logo
You’ll immediately recognize BlueCard PPO members
by the special "PPO in a suitcase" logo
on their ID card. BlueCard PPO members are Blue Plan
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 member ID cards carry this logo. Members
traveling or living outside of their Blue Plan’s
area receive the PPO level of benefits when they obtain
services from designated PPO providers.
- To find out if you're a BlueCard PPO provider,
visit www.bcbs.com.
No suitcase logo
If the member's ID card has an alpha prefix but does
not have a suitcase logo, send the claim to your local
plan - Regence BlueShield.
Identifying international members: Occasionally,
you may see ID cards from international Blue Plan members.
- These ID cards will also contain three-character
alpha prefixes. For example, "JIS" indicates
Blue Cross and Blue Shield of Israel members.
- The BlueCard claims process for international members
is the same as that for domestic Blue Plan members.
Verifying BlueCard Member Eligibility
Once you've identified the alpha prefix, you can verify
member eligibility and benefits by phone or by submitting
electronic inquiries.
Phone: Call BlueCard Eligibility at 1 (800)
676-BLUE (2583). An operator will ask you for the alpha
prefix on the member’s ID card and will connect
you to the Customer Service unit at the member’s
Blue Plan. If you are unable to locate an alpha prefix
on the member’s ID card, check for a phone number
on the back of the ID card.
Electronic Inquiry: Submit a HIPAA 270 transaction
(eligibility) to Regence BlueShield. The majority of BlueCard
electronic inquiries are answered within 48-72 hours
(Monday through Friday during regular business hours).
BlueCard Utilization Review (Precertification/Preauthorization)
You should remind patients that they are responsible
for obtaining precertification/preauthorization for
their services from their Blue Plan.
You may also choose to contact the member's Blue Plan
on behalf of the member by phone or electronic inquiries.
Phone: Call the Phone number listed on the
back of the member’s ID card or BlueCard Eligibility
at 1 (800) 676-BLUE (2583). You will be prompted for
the member's alpha prefix and connected with the appropriate
Blue Plan. Ask to be transferred to the utilization
review area.
Electronic inquiry: Submit a HIPAA 278 transaction
(referral/authorization) to Regence BlueShield. The majority
of BlueCard electronic inquiries are answered within
48-72 hours (Monday through Friday during regular business
hours).
Claims payment process
Once Regence BlueShield receives a claim, we will price
the claim based on your contract with us. Regence BlueShield
also determines your network participation, either participating
or preferred.
- We electronically route the claim to the member's
Blue Plan.
- The member's Blue Plan adjudicates the claim and
approves payment based on the member's benefit. The
member's Blue Plan determines and/or applies preauthorization
requirements, medical policies, and any state mandates.
- Regence BlueShield will reimburse you accordingly and
provide information on your voucher.
- Please note: If you haven't received payment, do
not resubmit the claim. If you do, the claim may be
denied as a duplicate. The member will also receive
another Explanation of Benefits (EOB). Please understand
that the timing of claims processing varies at each
Blue Plan. The standard time for non-investigational
claims processing at Regence BlueShield is 20 business
days from the time the claim is received in our office.
Claims submission
You should always submit claims electronically with
other Regence BlueShield claims or send paper claims to:
Regence BlueShield
P.O. Box 30271
Salt Lake City, UT 84130-0271
Be sure to include the member’s complete ID number
when you submit the claim. The complete ID number includes
the three-character alpha prefix. It's important that
you do not add or delete any alpha/numeric characters
to the member's ID number. Claims with incorrect or
missing alpha prefixes and member ID numbers delay claims
processing.
Do not send duplicate claims.
International claims
The claim submission process for international Blue
Plan claims is the same as domestic Blue Plan claims.
You should submit the claim directly to Regence BlueShield.
Exceptions to BlueCard claims submissions
Submit claims directly to the member's Blue Plan instead
of Regence BlueShield in the following situations:
- You contract with the member's Blue Plan.
- The member's ID 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 send the claim to us electronically
or send the paper claim to us at the address listed
above.
Indirect, support or remote 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 BlueShield.
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
limited to:
- prosthesis manufacturers,
- durable medical equipment suppliers,
- independent or chain laboratories, or
- telemedicine providers.
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