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.
For claim questions, contact your local, in-state Blue plan.
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.
Blue High Performance Network
Blue Plans may also offer plans with a national limited network of providers called the Blue High Performance NetworkSM (Blue HPNSM). In Massachusetts, this national network will be paired with our Exclusive Provider Organization (EPO) plan, Advantage Blue Performance. Coverage in plans with the Blue HPN are limited to emergency services at a hospital only when performed by non-HPN providers.
Plan: One of the 34 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. |
BlueCard members have a suitcase logo on their ID card.
Blue Cross Blue Shield member ID numbers begin with a three-character 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.
You can recognize patients with Blue HPN (a limited network of providers) by the Blue High Performance name and the “BlueHPN in a suitcase” logo on the member ID card (shown below).
You can follow the same pre-service review and claims filing procedures you use today for BlueCard PPO patients.
Note that the level of detail returned in your results will vary from Plan to Plan.
You can determine eligibility for out-of-area Blue Cross Blue Shield members by:
- Using ConnectCenter
- Submitting a HIPAA-compliant 270 through Direct Connection or through a clearinghouse
- Calling BlueCard® Eligibility at 1-800-676-BLUE (2583).
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 by:
- Using ConnectCenter
- Submitting a HIPAA-compliant 278 through Direct Connection or through a clearinghouse
You can submit pre-certification and pre-authorization requests for out-of-area Blue Cross Blue Shield members by:
- Submitting a HIPAA-compliant 278 through Direct Connection 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)
Submit claims the same way you do for Massachusetts members.
