BlueCard is a national program that allows Blue Cross and Blue Shield members to obtain health care services while traveling or living in another Blue Cross and Blue Shield service area.
The BlueCard program links health care providers with Blue Cross and Blue Shield plans across the nation through a single electronic network for claims processing and reimbursement. The BlueCard program also links providers in more than 200 countries and territories worldwide. Through BlueCard, you may submit claims for patients from other Blue Cross and Blue Shield plans (domestic or international) to your local Blue Cross and Blue Shield health plan. For your convenience, your local Blue Cross and Blue Shield plan is your single point of contact for customer service and claim inquiries and adjustments. View our news and updates for any BlueCard communications.
Filing claims for services provided to BlueCard members is the same as claims filing for local Blue Cross and Blue Shield members. Just submit the claims to your local Blue Plan. It’s as simple as that. For faster claims processing, submit your claims electronically.
You may request copayments from BlueCard members, but please do not request full payment up front unless an eligibility check shows that the service you are providing is not covered under the member’s benefit. For instance, if the member does not have coverage for non-emergency outpatient or physician services, collect payment for these non-covered services.
You can check the claims status online for BlueCard members. You will be asked to enter your username and password to access this secure area of our website. If you are not already a registered user, you may register online. It's fast and easy!
If you have any questions about the BlueCard program or filing claims for BlueCard members, contact your Provider Relations Representative or Provider Service.
Verify eligibility for BlueCard members via our website You will be asked to enter your username and password to access this secure area of our website. If you are not already a registered user, you may register online. It's fast and easy! You may also call 1-800-676-BLUE (2583) to verify member eligibility
Occasionally, you may see patients who present member cards from a foreign country. These member cards will contain a similar prefix to that of the domestic Blue Plan members’ cards. You will follow the very same steps to verify eligibility for international members that you do for domestic members.
Member cards have a prefix at the beginning of the member number. The prefix is a key to ensuring prompt payment. It is used to identify and correctly route claims and also to confirm membership and coverage.
We recommend that you make a copy of the front and back of the Member's card at every visit to ensure that you have the most up-to-date information on file.
For claim submissions, always enter the information exactly as it appears on the member card, including the prefix and all of the numbers that follow. Do not substitute the patient's Social Security number for his or her member number.
Many BlueCard members have a suit case logo on their ID cards which helps to identify their participation.
Remember, member cards are for identification purposes only; they do not guarantee eligibility or payment of your claim. Always verify patient eligibility via our website. You will be asked to enter your username and password to enter this secure area of our website. If you are not already a registered user, you may register online. It’s fast and easy. You may also call 1-800-676-BLUE (2583) to verify member eligibility.
Unique Claim Filing Rules:
Generally, claims should be filed with your local Blue Cross and Blue Shield plan. However, there are unique circumstances when claim filing directions will differ based on the type of provider and service.
Air Ambulance Claims
Emergency and non-emergency air ambulance claims are to be filed to the Plan in whose service area the point of pickup zip code is located.
File claim with the Blue Plan in whose service area the referring/ordering provider is located.
|Independent Clinical Laboratory|
|Provider Type||Any laboratory except hospital-based or physician office labs Types of service include, but are not limited to: blood, urine, samples, analysis, etc.|
|How to file (required fields)||
|Where to file||File the claim to the Plan in whose service area the referring provider is located.|
|Example||Blood is drawn* in laboratory or office setting located in Excellus BCBS’s service area. Blood analysis is done in California.File to: Excellus BCBS. *Claims for the analysis of a lab must be filed to the Plan in whose service area the referring provider is located.|
File claim with the Blue Plan in whose state the equipment was shipped to or purchased at a retail store. If you contract with more than one Blue Plan in a state for the same product type (i.e., PPO or traditional indemnity), you may file the claim with either Plan.
|Durable/Home Medical Equipment and Supplies|
|Provider Type||Types of service include, but are not limited to: hospital beds, oxygen equipment, crutches, etc.|
|How to file (required fields)||
Place of service (POS):
Service facility location information:
|Where to file||File the claim to the Plan in whose service area the equipment was shipped to or purchased in a retail store.|
File claim with the Blue Plan in whose state the referring/ordering physician is located. If you contract with more than one Blue Plan in a state for the same product type (i.e., PPO or traditional indemnity), you may file the claim with either Plan.
|Provider Type||Types of service (non-routine, biological therapeutics ordered by a health care professional as a covered medical benefit as defined by the member's Plan's specialty pharmacy formulary): include, but are not limited to: injectable, infusion therapies, etc.|
|How to file (required fields)||
|Where to file||File the claim to the Plan whose service area the referring/ordering physician is located.|
|Example||Patient is seen by a physician in Excellus BCBS's service area who orders a specialty pharmacy injectable for this patient. Patient will receive the injections in Florida where the member lives for six months of the year. File to: Excellus BCBS.|
Exception: The guidelines in the charts above do not apply to claims submitted for Federal Employee Program Members. Please continue to follow the FEP claims filing guidelines
- Ancillary claim filing rules for clinical lab, DME and specialty pharmacy apply regardless of the provider's contracting status with multiple Plans.
- Prior to rendering service, providers are encouraged to use our website to verify member eligibility and benefits. You may also call the BlueCard Eligibility line at 1-800-676-BLUE (2583).
- Providers who use outside vendors to provide services (i.e., send blood specimen for special analysis that cannot be done by the laboratory where the specimen was drawn) should use in-network participating ancillary providers to reduce the possibly of additional member liability for covered benefits. View in-network participating providers in our provider directory available at: member.excellusbcbs.com/find-a-doctor/provider
- Providers who wish to establish Participating Provider Agreements with other Plans should contact each Plan's Contracting department.
If you have any questions about where to file your ancillary claim, contact your local Blue Plan’s Provider Service department or call the BlueCard Eligibility line at 1-800-676-BLUE (2583).