BlueCard tutorial BlueCard Program Basics · After completing the BlueCard® Program Basics...

BlueCard tutorial: BlueCard Program Basicsquestions: [email protected]

version 5 – updated 12.01.2016

Welcome to BlueCard

After completing the BlueCard® Program Basics tutorial, you will be able to:

• Understand BlueCard Program basic facts and processes

• Know the benefits of submitting your BlueCard claims to Blue Shield of California

• Understand the services Blue Shield provides you for the BlueCard Program

• Know how to contact us for help and information

BlueCard tutorial BlueCard Program Basics



BlueCard Program Basics

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Understanding BlueCard • The BlueCard® Program is a national program that allows Blue plan members to

obtain healthcare services in another Blue plan service area.

• Represents your patients insured by out-of-state Blue Cross Blue Shield plans.

• The program links participating healthcare providers and independent Blue Cross and Blue Shield (BCBS) plans through a secured electronic network for claims processing and reimbursement.

• There is a significant California patient population insured by other states Blue plans and can access medical services from you.

• One in three Americans receive healthcare coverage from a Blue plan. That’s more than 100 million Americans!

As a participating provider with Blue Shield of California, you are a BlueCard service provider.

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BlueCard Program Basics Blue Shield of California advantages

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Blue Shield of California offers you fast and easy claims processing for out-of-state BlueCross BlueShield plan patients.


• Timely processing of BlueCard professional and facility claims

• Local-payer solution for submitting BlueCard claims. Since we’reCalifornia-based and non-profit, we’re better able to support localproviders & customers.

• Online tools help you to streamline your BlueCard processes and serveBlue plan members

• Dedicated local service team to assist you with questions and requestsat (800) 622-0632

• Training and educational resources to support your BlueCard transactions



Including the three character prefix, subscriber numbers can contain up to 17 characters.

BlueCard Program Basics Blue Plan identification cards

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The three character prefix is a key identifier in the BlueCard Program.

BlueCard Program Basics All about prefixes

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• The three character prefix precedes the subscriber ID number.

• The three character prefix is essential for accurately identifying whichBlue plan insures the member.

• The three character prefix is used when verifying eligibility and benefits,requesting authorizations, processing claims or checking claims statusand for all inquiries and correspondence.



BlueCard Program Basics BlueCard claims are easy to submit

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• Use our Claims Routing Tool to instantly find where to submit your claims.

• Submit your claims electronically for faster processing.

• BlueCard claims – including hospital, ASC, professional and ancillary – can be processed by Blue Shield of California

Specific claims not processed via BlueCard Program are:

• FederalEmployeesProgram (FEP)

• Vision plan(stand-alonevision plan)

• Prescription drug



Blue Shield of California processes claims in accordance to your local BSC network contract.

BlueCard Program Basics Blue Plan responsibilities

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Blue Shield of California will:• Process claims from you

• Send the claim to the member’s Blue plan electronically

• Remit applicable payment and Explanation of Benefitsdirectly to you

• Answer your BlueCard claims questions

The member’s Blue plan will:• Accept claims from Blue Shield of California

• Verify the member’s eligibility and benefit coverage

• Manage all necessary medical authorizations

• Authorize Blue Shield to finalize claim

• Send an Explanation of Benefits to the member

• Answer member questions



BlueCard Program Basics Provider Connection features

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• Verify eligibility, benefits information & share of cost

• Use our Claims Routing Tool to determine where to send BlueCard claims

• Request authorizations using our Electronic Provider Access (EPA) tool

• Obtain out-of-state Blue plan medical policies

• Verify other Blue plan pre-authorization requirements

• View claims status, payment status & EOBs

• Preview BlueCard Program tutorials

• Access professional provider fee schedule

• Download provider manuals and guidelines

www.blueshieldca.com/provider




BlueCard Program Basics BlueCard Program Online

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All the tools you’ll need to help serve out-of- state Blue plan members are located on the main BlueCard Program page.




BlueCard Program Basics conclusion


Congratulations. You have completed the BlueCard Program Basics tutorial.

We encourage you to continue your learning. The BlueCard Tutorials Web page contains other informative BlueCard tutorials, plus additional resources you may find helpful.

BlueCard claims mailing address:Blue Shield of California BlueCard Program P.O. Box 1505 Red Bluff, CA 96080-1505

For questions related to:• BlueCard eligibility: (800) 676-BLUE (2583)• BlueCard Claims Unit: (800) 622-0632• Authorization requests: Call the Medical

Management number printed on the back ofthe member's ID card

• Web technical support: (800) 541-6652

Your online resources for:• Member eligibility - blueshieldca.com/provider/eligibility-benefits/eligibility-search/home.sp?cardType=otherplan• Authorization requests - blueshieldca.com/provider/authorizations/pre-service-review/electronic-access/home.sp• Claims status - blueshieldca.com/provider/claims/search/home.sp

https://www.blueshieldca.com/provider/claims/bcresources/bctutorials.jhtml

BlueCard Tutorial: BlueCard Program Basicsquestions: [email protected]

version 4.2 – updated 1.30.2012

Welcome to BlueCard

After completing the BlueCard Program Basics tutorial, you will be able to:

• Understand BlueCard Program basic facts and processes

• Know the benefits of submitting your BlueCard claims to Blue Shield of California

• Understand the services Blue Shield provides you for the BlueCard Program

• Know how to contact us for help and information

BlueCard TutorialBlueCard Program Basics

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12/01/2016

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BlueCard Program Basics

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Understanding BlueCard The BlueCard Program is a national program that links participating healthcare providers with Blue Cross Blue Shield plans across the country and worldwide through a single, electronic network for claims processing and reimbursement.

The program represents your patient population insured by other states’ Blue plans. • One in three Americans receive healthcare coverage from a Blue plan.

• There is a significant patient population in California insured by out-of-state Blue plans.

As a participating provider with Blue Shield of California, you are a BlueCard service provider.




• We remit claims payment directly to you – Blue Shield processes all BlueCard claim types within seven days on average.

• We offer a local-payer solution for submitting your BlueCard claims.

• We help streamline your operational processes with our online tools.

• We provide you and your staff training and educational resources to help you serve Blue plan members.

BlueCard Program Basics Blue Shield of California Advantages

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Blue Shield of California is a not-for- profit healthcare company that serves all of California, which means we focus on our members and not shareholders.




Subscriber numbers can contain up to 17 alpha-numeric characters including the three-letter alpha prefix.

BlueCard Program Basics Membership Cards

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Identify an out-of-state Blue plan member with three key elements:

• Any Blue-branded logo(either a single or double logo)

• Three-character alpha prefix that precedes the subscriber ID number

• Suitcase symbol (with or without “PPO” inside the suitcase)



The three-letter alpha prefix is a key identifier for the BlueCard Program.

BlueCard Program Basics Alpha Prefix

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• The three-letter alpha prefix precedes the subscriber ID number.

• The alpha prefix is essential for accurately identifying which Blue plan insures the member.

• The alpha-prefix is used when verifying eligibility and benefits, requesting authorizations, processing claims or checking claims status and for all inquiries and correspondence.



BlueCard Program Basics BlueCard claims are easy to submit

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Use our Claims Routing Tool to instantly find where to submit your claims.• Submit your claims electronically for faster processing.

Several types of claims processed by Blue Shield do not use the BlueCard Program:

• Federal Employees Program (FEP)

• Vision plan (Stand-alone vision plan)

• Prescription drug



Blue Shield of California determines payment for your BlueCard claims according to your local BSC network contract.

BlueCard Program Basics Blue Plan Responsibilities

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As a host Blue plan, Blue Shield of California will:• Process claims from you

• Send the claim to the member’s Blue plan electronically

• Remit payment or explanation of benefits directly to you

• Answer your BlueCard claim questions

The member’s home Blue plan will:• Accept claims from Blue Shield of California

• Verify the member’s eligibility and benefit coverage

• Approve the member’s authorization on certain medical services

• Authorize Blue Shield to finalize and pay the claim

• Send an explanation of benefits to the member

• Answer member questions



BlueCard Program Basics BlueCard Online Tutorials

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Our BlueCard online tutorials help you to learn to use our online tools more effectively – when it is convenient for you and at your own pace.

• Search Eligibility & BenefitsLearn how to use our online Eligibility and Benefits search features to find eligibility and benefits information for out-of-state Blue plan members and understand the results.

• Request AuthorizationsLearn how to submit an authorization request online for out-of-state Blue plan member, and find the results in your Message Center.

• Medical Policy and Prior Authorization TrackingLearn how to access the medical policies and prior authorization details for services being considered for out-of-state Blue plan members.

• Claims Routing ToolLearn how to use the Claims Routing Tool to instantly find where to send your BlueCard claims and locate the BlueCard claims mailing address.

• Claims Status SearchLearn how to use the Claims search features to find status for your BlueCard claims and BlueCard resources that support billing and payment.

• BlueCard ResourcesLearn how to find online BlueCard resources that can help answer your BlueCard questions.

View our online BlueCard Tutorials for self-paced training on the topics you need most.




BlueCard Program Basics BlueCard Program Online

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All the tools you’ll need to help serve out-of- state Blue members are located on the main BlueCard Program page.


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BlueCard Program Basics Conclusion


Congratulations. You have completed the BlueCard Program Basics tutorial.

We encourage you to continue your learning. The BlueCard Tutorials web page contains other informative BlueCard tutorials, plus additional resources you may find helpful.

For questions related to: BlueCard Claims Mailing Address:

BlueCard Eligibility Questions: 800-676-2583BlueCard Claims Unit: 800-622-0632EDI Help Desk: 800-480-1221Web Help Desk: (877) 932-3375

Blue Shield of CaliforniaBlueCard Program, P.O. Box 1505Red Bluff, CA 96080-1505

To reach a BlueCard Marketing Consultant, email [email protected]

https://www.blueshieldca.com/provider/claims/bcresources/bctutorials.jhtml

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(800) 676- BLUE (2583)

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Web technical support at (800) 541- 6652

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Your online resources for: • Member eligibility - www. blueshieldca. com/ provider/ eligibilitybenefits/ eligibilitysearch/ home. sp? cardType= otherplan • Authorization request - www. blueshieldca. com/ provider/ authorizations/ preservicereview /electronicaccess/ home. sp • Claims status - www. blueshieldca. com/ provider/ claims/ search/ home. sp

BlueCard tutorial BlueCard Program Basics · After completing the BlueCard® Program Basics...

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