Claims and Products included
The BlueCard Program applies to all inpatient, outpatient and professional claims. This includes:

• Traditional
• Preferred Provider Organization (PPO)
• Point-of-Service (POS)
• Health Maintenance Organization (HMO) products

Benefits and claims exempt
The following benefits are exempt from BlueCard:

• Dental services
• Prescription medications

In addition, claims for the Federal Employee Program (FEP) are exempt from the program.

Identifying BlueCard Members
Always ask members for their current Blue Plan member 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 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 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 card for instructions on where to file claims for these members.

Suitcase logo
In addition to the alpha prefix, member cards may also have:

• A blank suitcase logo
• A PPO in the suitcase logo for eligible PPO members or
• No suitcase logo

  Blank suitcase logo
  A blank suitcase logo on the member card means that the patient has traditional, POS or HMO benefits delivered through the BlueCard Program.

  • If a member is enrolled in a primary care physician (PCP) panel, the member card will include an office visit copayment, if applicable.

  PPO in a Suitcase Logo
  You’ll immediately recognize BlueCard PPO members by the special "PPO in a suitcase" logo on their member 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 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 card has an alpha prefix but does not have a suitcase logo, send the claim to your local plan - Regence BlueShield of Idaho.

Identifying international members: Occasionally, you may see member cards from international Blue Plan members.

• These member cards will also contain three-character alpha prefixes. For example, "URU" indicates BlueCross and BlueShield of Uruguay 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 card and will connect you to the Customer Service unit at the member’s Blue Plan.

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

Pre-authorization
You should remind patients that they are responsible for obtaining pre-certification/pre-authorization 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 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 an ANSI 278 transaction (referral/authorization) to Regence BlueShield of Idaho. The majority of BlueCard electronic inquiries are answered within 48-72 hours (Monday through Friday during regular business hours).

Claims payment process

1. Once Regence BlueShield of Idaho receives a claim, we will price the claim based on your contract with us. Regence BlueShield of Idaho also determines your network participation, either participating or preferred.
2. We electronically route the claim to the member's Blue Plan.
3. 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 pre-authorization requirements, medical policies and any state mandates.
4. Regence BlueShield of Idaho will reimburse you accordingly and provide information on your voucher.

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 of Idaho is 30 business days from the time the claim is received in our office.

Claims submission
You should always submit claims electronically with other Regence BlueShield of Idaho claims or send paper claims to:

Regence BlueShield of Idaho
P.O. Box 31603
Salt Lake City, UT 84131-0603

Be sure to include the complete member number when you submit the claim. The complete member 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 number. Claims with incorrect or missing alpha prefixes and member 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 of Idaho.

Exceptions to BlueCard claims submissions
Submit claims directly to the member's Blue Plan instead of Regence BlueShield of Idaho 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 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 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 BlueShield of Idaho.