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BlueCard® Program
BlueCard® is a national program that enables members to get health care services while traveling or living in another Blue plan service area.
It uses a single claims processing and reimbursement network to link independent Blue Cross Blue Shield (BCBS) plans and providers. As a Blue Cross Blue Shield of North Dakota (BCBSND) provider, the BlueCard program allows you to submit claims locally for visiting Blue plan members.
As a provider, there are three main responsibilities when participating in the BlueCard program, which include:
- View the member insurance ID card
- Verify eligibility and benefits
- Submit BlueCard claims electronically according to the appropriate guidelines
Note: Medicaid Expansion information may vary due to the type of product.
Additional information such as how the program works, how to file claims and contiguous county guidelines, can be found in the section BlueCard Program within the provider manuals.
How to Identify BlueCard Members
When out-of-area BCBS members arrive at your office or facility, be sure to ask them for their current membership ID card. The two main identifiers for BlueCard members are the prefix and a “suitcase” logo, reference provider manual(s) for specifics.
How to Verify BlueCard Member 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) to be directed to the correct plan to verify eligibility and benefits.
When contacting the BlueCard Eligibility Line, use the phonetic alphabet when entering the alpha prefix, this will help ensure calls are routed to the correct plan.
BlueCard Coordination of Benefits (COB) Questionnaire
If a provider is aware of a member having additional coverage, they can utilize the
COB Questionnaire form located here.
Providers have the choice to:
- Instruct the member to submit the form to their local home plan; or
- The provider can submit the questionnaire to the local plan in which they provided services
BlueCard Glossary
Defines terminology associated with the BlueCard program. More health insurance definitions such as deductible, can be found within the provider manual(s).
Term | Definition |
Blue Distinction® Centers for Transplants (BDCT) | A program consisting of a national network of transplant centers that provide comprehensive transplant services through a coordinated, streamlined referral management program and meets specific participation criteria that consider not only provider qualifications and program process, but patient outcomes as well. |
Blue Distinction® Centers | Facilities that are recognized for providing quality specialty care. Use BDC when referring to a designated facility that met quality selection criteria only. |
Blue Distinction® Centers+ | Facilities that are recognized for providing quality specialty care and efficiency. Use BDC+ when referring to a designated facility that met quality and cost selection criteria. |
BlueCard Access | A toll-free 800 number, 1-800-810-BLUE, providers, and members can use to locate providers in another Blue Cross Blue Shield plan’s area. This number is useful when you need to refer the patient to a physician or healthcare facility in another location. |
BlueCard Eligibility | A toll-free 800 number, 1-800-676-BLUE, for providers to verify membership and coverage information on patients from other Blue Cross Blue Shield plans. |
BlueCard Program | A program that enables subscribers to obtain health services while traveling or living in another BCBS licensee’s service area and receive the benefits of their Blue Cross subscriber contract. |
Coordination of Benefits (COB) | Ensures that members receive full benefits and prevents double payment for services when a member has coverage from two or more sources. The language gives the order for what insurance organization has primary responsibility for the payment and what insurance organization has secondary responsibility for payment and how the two coordinate. |
Electronic Claims Routing Process | A method Blue Cross and Blue Shield of North Dakota uses to electronically forward your claims data to the member’s Blue plan for those alpha prefixes or accounts that are exempt from the BlueCard Program |
www.bcbs.com | Blue Cross and Blue Shield Association’s Web site, which contains useful information for providers. |
Prefix | Three characters preceding the member identification number on Blue Cross Blue Shield ID cards required for routing claims. |
