About the BlueCard Program
The BlueCard Program connects providers of 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. 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.
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.
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.
If you are a Wellmark participating provider, check eligibility and benefit information the Out-of-area Membership Search tool Secure Site.
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).
Submitting BlueCard claims
Have a BlueCard claim? Here’s the process for filing:
- Member with an out-of-state BCBS Plan receives services from a Wellmark provider.
- The Wellmark provider submits the claim to Wellmark.
- Wellmark recognizes the BlueCard member and transmits the claim to the member’s BCBS Plan.
- The member’s BCBS Plan adjudicates the claim according to member’s benefit Plan.
- The member’s BCBS Plan issues an Explanation of Benefits (EOB) to the member.
- The member’s BCBS Plan transmits claim payment information to the local provider’s BCBS Plan.
- Wellmark reimburses participating providers and issues the Provider Claims Remittance (PCR).
Tips for submitting BlueCard claims
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 Site tool.
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 Site.
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 page Secure Site for information regarding ancillary claims filing.
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
Note: A contiguous county is considered a county that borders another BCBS Plan’s service area.
In addition to the information above, you may find the following resources helpful.
- Blue Cross Blue Shield Global Claim Forms
- Bookmark the Claims Filing Secure Site section of the provider guide
- Guide to Medicaid Provider Enrollment Requirements PDF File
- Reporting Encounter Data for Medicaid claims PDF File (CPT and Revenue Codes)
- Questions and answers PDF File for Medicaid Claims