BlueCard Tutorial BlueCard Program Basics
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- Valerie Byrd
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1 BlueCard Tutorial Welcome to BlueCard After completing the tutorial, you will be able to: Understand 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 Know how to contact us for help and information
2 page 2 of 10 As a participating provider with Blue Shield of California, you are a BlueCard service provider. Understanding BlueCard The 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.
3 page 3 of 10 Blue Shield of California is a not-forprofit healthcare company that serves all of California, which means we focus on our members and not shareholders. Blue Shield of California Advantages 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.
4 page 4 of 10 Subscriber numbers can contain up to 17 alpha-numeric characters including the three-letter alpha prefix. Membership Cards 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)
5 page 5 of 10 The three-letter alpha prefix is a key identifier for the BlueCard Program. Alpha Prefix 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.
6 page 6 of 10 BlueCard claims are easy to submit 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
7 page 7 of 10 Blue Shield of California determines payment for your BlueCard claims according to your local BSC network contract. Blue Plan Responsibilities 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
8 page 8 of 10 View our online BlueCard Tutorials for self-paced training on the topics you need most. BlueCard Online Tutorials 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 & Benefits Learn 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 Authorizations Learn 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 Tracking Learn how to access the medical policies and prior authorization details for services being considered for out-of-state Blue plan members. Claims Routing Tool Learn 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 Search Learn how to use the Claims search features to find status for your BlueCard claims and BlueCard resources that support billing and payment. BlueCard Resources Learn how to find online BlueCard resources that can help answer your BlueCard questions.
9 page 9 of 10 Online All the tools you ll need to help serve out-ofstate Blue members are located on the main page.
10 Conclusion Congratulations. You have completed the 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 Eligibility Questions: BlueCard Claims Unit: EDI Help Desk: Web Help Desk: (877) BlueCard Claims Mailing Address: Blue Shield of California, P.O. Box 1505 Red Bluff, CA To reach a BlueCard Marketing Consultant, bluecardmarketing@blueshieldca.com home previous next
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