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BlueCard® Program

The BlueCard Program links providers to all Blue Cross and Blue Shield (BCBS) Plans across the country and around the world through an electronic network of claims processing and payment. The BlueCard Program typically applies when a provider contracted with Wellmark is servicing a member of another BCBS Plan. For providers, the BlueCard program is your one-stop shop for claims submissions, inquiries, status updates, and payment for BlueCard members. BlueCard also provides easy access to member eligibility, benefits and authorizations.

Overview

Identifying a BlueCard Member

To determine whether the member has coverage outside his/her local BCBS Plan’s service area, look for the suitcase logo on the ID card.

 

 ID Card

Letters within the suitcase logo indicate the member has Preferred Provider Organization (PPO) or Exclusive Provider Organization (EPO) coverage for medical services received within or outside the United States. It also means the provider will be reimbursed for covered services in accordance with the provider’s PPO contract with the local BCBS Plan.

 

A blank (empty) suitcase logo indicates the member has a traditional product such as Health Maintenance Organization (HMO) or Point of Service (POS) products. Out-of-network benefits may or be available; check the member benefits prior to providing services.

 

If there is no suitcase on the ID card, the member does not have BlueCard coverage. Please note, BCBS Plan ID cards for Medicaid members do not include the suitcase logo, but they do include a disclaimer on the back of the ID card providing information on benefit limitations. For members with such ID cards, you should obtain eligibility and benefit information and prior authorization for services using the same tools as you would for other BCBS members.

Eligibility and Benefits

If you are a Wellmark participating provider, the easiest way to check eligibility and benefit information is through the Out-of-area Membership Search tool Secure.

 

If you are an out-of-state provider and participate with another BCBS Plan, you can access eligibility and benefits information through your local BCBS Plan’s website. When conducting your search, make sure to include the first three alpha characters on the Wellmark member’s ID card. You can also call 800-676-BLUE (2583). 

BlueCard Claim Process

Have a BlueCard claim? Here’s what to expect.

  1. Member with an out-of-state BCBS Plan receives services from a Wellmark provider.
  2. The provider submits the claim to Wellmark.
  3. Wellmark recognizes the BlueCard member, and transmits the claim to the member’s BCBS Plan.
  4. The member’s BCBS Plan adjudicates the claim according to member’s benefit Plan.
  5. The member’s BCBS Plan issues an Explanation of Benefits (EOB) to the member.
  6. The member’s BCBS Plan transmits claim payment information to the provider’s local BCBS Plan.
  7. Wellmark reimburses participating providers and issues the Provider Claims Remittance (PCR).

Contiguous Counties

A contiguous county is considered a county that borders another BCBS Plan’s service area.

PPO Providers

Providers that are located in a contiguous county to Wellmark’s service area and are PPO providers with both plans must file PPO claims for Wellmark members with the BCBS Plan where the member lives or works.

 

Claims filing rules for contiguous county providers are based on the permitted terms of the provider contract:

  • Provider’s physical location
  • Provider’s PPO contract status with the two contiguous counties
  • The member’s Home Plan and where the member lives
  • The location of where the member received services

HMO/POS Providers

Providers that are located in a contiguous county to Wellmark’s service area and are HMO/POS providers with Wellmark must file HMO/POS claims for Wellmark members with Wellmark.

 

Providers that are not HMO/POS providers with Wellmark must file their claims with their Home (local) Plan.

 

Contiguous county claims filing is different from ancillary claims filing. Refer to the Ancillary Claims Filing section below for information regarding ancillary claims filing.

Tips for BlueCard Claim Submissions

To ensure smooth processing and payment of your claims, please remember to:

  • Keep up-to-date patient information and ID card copies.
  • Verify BlueCard member benefits, check applicable medical policies and initiate an out-of-area member authorization.
  • File the claim to the provider’s local BCBS Plan.
  • Obtain claim status and submit claim inquiries through your local BCBS Plan. Wellmark providers can check claim status using the Check a Claim Secure tool.  

Ancillary Claims

Claims for independent clinical laboratory services, durable medical equipment, and specialty pharmacy services should be filed to the local BCBS Plan, as described for ancillary services in accordance with the Ancillary Claims Filing instructions. Secure

Blue Cross Blue Shield Global Core

Blue Cross Blue Shield Global Core is a network of more than 9,000 hospitals and 21,000 health care professionals and outpatient care centers around the world. This is provided to members who are traveling or living outside the United States, Puerto Rico, and the U.S. Virgin Islands. Claims support, referrals to providers, translation services and medical motoring is provided to members 24 hours a day, 365 days a year.

Additional Resources

In addition to the information above, you may find the following resources helpful.



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