BCBS Blue Card Program Overview and Resources

The BCBS Blue Card Program is designed to provide healthcare coverage to individuals and families who live and work in certain areas.

The program is administered by Blue Cross and Blue Shield (BCBS) companies, which are independent and locally operated.

BCBS companies have a network of healthcare providers that participate in the Blue Card Program, making it easier for members to find in-network care.

With the Blue Card Program, members can receive care from any participating provider, no matter where they are in the country.

The BlueCard Program is a convenient way for providers to work with members from other Blue Cross and Blue Shield (BCBS) Plans. It connects providers across the country and around the world through an electronic network.

To access the BlueCard Program, providers can call Blue Card Eligibility at 800-676-BLUE (2583) and enter the three-character prefix on the member's ID number. This will route the call to the member's home plan.

The program provides easy access to member eligibility, benefits, and authorizations, making it a one-stop-shop for claims submissions, inquiries, status updates, and payment.

Here are the steps to identify BlueCard members and verify their eligibility:

You can verify eligibility by telephone or electronically through Availity Essentials. If you need to obtain pre-certification for a BlueCard member, you can call Blue Card Eligibility and ask to be transferred to the Medical Management Department.

As a member of BCBS Blue Card, you'll have access to a vast network of healthcare providers and facilities.

You can find a doctor or specialist in your area by visiting the BCBS Blue Card website.

BCBS Blue Card offers a variety of membership plans to fit your needs and budget.

You can choose from individual, family, and group plans, each with its own set of benefits and premiums.

To find more information about your specific plan, including coverage details and out-of-pocket costs, log in to your BCBS Blue Card account online.

BCBS Blue Card also offers a range of tools and resources to help you manage your healthcare and stay healthy.

If you're a provider working with BlueCard members, it's essential to understand the claims process. To file a BlueCard claim, the Wellmark provider submits the claim to Wellmark, which then transmits it to the member's BCBS Plan.

You can check benefits and eligibility for BlueCard members by calling 800-676-BLUE (2583) and providing the prefix, or by using My Insurance Manager. The BlueCard Precertification tool can also be used to check if prior authorization is required.

To ensure smooth processing and payment of your claims, keep up-to-date patient information and ID card copies, verify BlueCard member benefits, and file the claim to the provider's local BCBS Plan. You can also check claim status and submit claim inquiries through your local BCBS Plan.

Here are the steps to submit a BlueCard claim:

To check claim status, visit My Insurance Manager. You can also use the Check a Claim Secure Site tool.

You can check benefits and eligibility for BlueCard members by calling 800-676-BLUE (2583) and providing the prefix.

To verify eligibility and benefits, call the Provider Service phone number on the back of the member's ID card or use the BlueCard Eligibility Line at 800-676-BLUE (2583).

You can also use the phonetic alphabet when entering the alpha prefix to ensure calls are routed to the correct plan. For example, use "Alpha" for the prefix A.

If you're a Wellmark participating provider, check eligibility and benefit information using the Out-of-area Membership Search tool Secure Site.

To access eligibility and benefits information as an out-of-state provider, go to your local BCBS Plan's website and include the first three alpha characters on the Wellmark member's ID card in your search.

You can also call 800-676-BLUE (2583) for assistance with checking benefits and eligibility.

If you're a South Carolina provider, submit claims to BlueCross BlueShield of South Carolina for faster processing.

You can submit claims electronically to BlueCross BlueShield of South Carolina directly, through a clearinghouse, or by using My Insurance Manager.

Please don't request full payment up front when submitting claims.

To check claim status, visit My Insurance Manager.

Submitting claims can be a straightforward process if you know the steps involved. To start, the BlueCard claim process begins when a member with an out-of-state BCBS Plan receives services from a Wellmark provider.

First, the Wellmark provider submits the claim to Wellmark, which then recognizes the BlueCard member and transmits the claim to the member's BCBS Plan. This is a crucial step, as it ensures that the claim is processed correctly.

The member's BCBS Plan then adjudicates the claim according to the member's benefit plan, and issues an Explanation of Benefits (EOB) to the member. This document outlines the details of the claim, including the amount paid and any remaining balance.

If you're a provider, you can obtain claim status and submit claim inquiries through your local BCBS Plan. Wellmark providers can also use the Check a Claim Secure Site tool to check claim status.

To ensure smooth processing and payment of your claims, be sure to keep up-to-date patient information and ID card copies. This will help prevent delays or errors in the claims process.

To verify BlueCard member eligibility and benefits, you can call the Provider Service phone number on the back of their ID card or use the BlueCard Eligibility Line at 800-676-BLUE (2583).

You'll need to provide the phonetic alphabet when entering the alpha prefix to ensure calls are routed to the correct plan. For example, use "Alpha" instead of "A".

If a provider is aware of a member having additional coverage, they can use the COB Questionnaire form to submit to the local home plan or the provider can submit it themselves.

To determine whether a member has BlueCard coverage, look for the suitcase logo on their ID card.

You can check eligibility and benefits for BlueCard members by calling 800-676-BLUE (2583) and providing the prefix from the patient's member ID card.

To verify eligibility and benefits, call the Provider Service phone number on the back of the members ID card or utilize the BlueCard Eligibility Line at 800-676-BLUE (2583).

Look for the suitcase logo on the ID card to determine whether the member has coverage outside his/her local BCBS Plan's service area.

The BlueCard Eligibility Line can be used to verify eligibility and benefits, and using the phonetic alphabet when entering the alpha prefix will help ensure calls are routed to the correct plan.

You can also check benefits and eligibility for BlueCard members by using My Insurance Manager.

The Blue Card Coordination of Benefits Questionnaire is a valuable tool for healthcare providers to navigate complex insurance situations. If a provider is aware of a member having additional coverage, they can utilize the COB Questionnaire form.

There are two ways to submit the questionnaire: the member can submit the form to their local home plan, or the provider can submit it to the local plan in which they provided services.

This questionnaire helps ensure that patients receive the care they need without facing unexpected costs or delays. By submitting the form, providers can help streamline the coordination of benefits process.

If you need help understanding the BlueCard Program, the BlueCard Provider Manual is a great resource to turn to. It includes information on verifying eligibility, prior authorization, and claims filing for out-of-area members.

You can also find frequently asked questions on the topic.

To get in touch with someone about the BlueCard Program or filing claims for out-of-area patients, simply email [email protected].