November 05, 2013
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management
The California Medical Association frequently gets calls from physicians about claim issues involving patients with out-of-state Blue Cross Blue Shield (BCBS) insurance, otherwise known as the BlueCard Program.
BlueCard is a national program that allows out-of-state BCBS patients to access services in another BCBS service area. Through a provision in the Anthem Blue Cross and Blue Shield of California contracts, physicians agree to allow the two payors to lease their provider networks to “other payors,” which includes these out-of-state BCBS plans.
This leasing agreement between local BCBS plans and out-of-state plans allows patients who have coverage through an out-of-state BCBS plan to receive in-network health care services from Anthem Blue Cross or Blue Shield of California providers in California.
Physicians who treat out-of-state BlueCard patients should submit the claims to their local Blue Cross or Blue Shield plan. However, while most claims can be sent to either of the local Blue plans, there are some claims that must go to one or the other.
Both plans offer a routing tool that allows providers to determine where to send the claim. Blue Shield’s routing tool, called the BlueCard Claims Routing Tool, can be found on its provider website (under “Helpful Resources,” click “BlueCard Program”). Blue Cross’s routing tool, called the BlueCard Claims Advisor, can be found on its Provider Access website (under “News & Information,” click “BlueCard Claims Advisor”). Both plans also offer BlueCard eligibility verification tools.