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BlueCard Program

The BlueCard® program is a national program that enables members of another Blue Cross Blue Shield plan to get health care service benefits while traveling or living in another Blue plan’s service area.

The program links participating health care providers and the independent Blue Cross Blue Shield plans across the country through a single electronic network for claims processing and reimbursement.

Benefits vary from plan to plan and state to state. Always check benefits and eligibility before rendering services.
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Key terms

Plan: One of the 36 independently operated “Blue Plans” in the Blue Cross and Blue Shield System.

Home plan (member’s plan): The Blue Cross plan the member has a contract with. The member’s benefits are determined by their Home plan.

Local plan: The area where the member got their care. Blue Cross Blue Shield of Massachusetts is usually considered the Local (or Host) plan. Contact us for all claims inquiries and follow-up. The Blue Cross electronic network enables accurate and timely payments, eliminating the need to track receivables from multiple carriers.

Here is a description of the Local plan for clinical laboratories and durable medical equipment providers:

The Local plan for a Is defined as the plan in the service area where
Clinical laboratory The specimen was drawn, which is determined by the location of the referring provider.
DME provider The equipment was shipped or purchased at a retail store.
How do I identify BlueCard members?

BlueCard members have a suitcase logo on their ID card.

Blue Cross Blue Shield member ID numbers begin with a three-letter prefix and can be up to 17 characters long. With any claim or electronic transaction, be sure to enter the ID number exactly as it appears on the member’s card.

Never guess a three-character prefix, or try to determine the prefix based on the patient’s Home plan.
How do I verify eligibility?

You can determine eligibility for out-of-area Blue Cross Blue Shield members by:

  • Using Online Services
  • Submitting a HIPAA-compliant 270 either directly or through a clearinghouse
  • Calling BlueCard® Eligibility at 1-800-676-BLUE (2583).
  • Using a POS device (a “swipe” box)

Note: The level of detail returned for BlueCard members varies.

How do I enter or verify a referral?

Verifying that a referral is on file and that the number of requested visits matches the services required helps facilitate the claims process and avoids unnecessary appeals or inquiries.

Enter and verify referrals electronically, the same way you do for Massachusetts members.

You can enter and check referrals for all members in managed care plans through one of the following eTools:

  • Using Online Services
  • Submitting a HIPAA-compliant 278 either directly or through a clearinghouse
  • Using a POS device (a “swipe” box)

Note: The level of detail returned for BlueCard members varies.

How do I request prior authorization?

You can submit pre-certification and pre-authorization requests for out-of-area Blue Cross Blue Shield members by:

  • Using Online Services
  • Submitting a HIPAA-compliant 278 either directly or through a clearinghouse
  • Using the Pre-service Review for BlueCard members tool for our out-of-area members
  • Calling BlueCard® Eligibility at 1-800-676-BLUE (2583). You can choose from four options depending on the type of service you need an authorization for:
    • Medical/surgical
    • Behavioral health
    • Diagnostic imaging/radiology
    • Durable medical equipment (DME)
  • Using the POS device (a “swipe” box)

Note: The level of detail returned for BlueCard members varies.

How do I submit claims?

Submit claims the same way you do for Massachusetts members.

Include the three-character prefix on all claims submissions, referrals to vendors, requests for lab work, and prescriptions for prosthetics, orthotics, and durable medical equipment. This three-letter prefix identifies them as BlueCard Program members. Be sure to set up internal systems to accommodate up to 17 ID card characters.