The BlueCard® Program

BlueCard links participating health-care providers and the Blue Cross and Blue Shield Plans throughout the country with a single electronic network for professional outpatient and inpatient claims processing and reimbursement. The program allows participating Blue Cross and Blue Shield providers in every state to submit claims for indemnity and PPO patients who are enrolled through another Blue Plan to their local Blue Cross and Blue Shield Plan.

Through the BlueCard program, providers can submit claims for Blue Cross and Blue Shield members they are treating that currently are covered by another Blue Cross and Blue Shield plan directly to Arkansas Blue Cross and Blue Shield electronically through AHIN. If you are an Arkansas provider, Arkansas Blue Cross is your sole necessary contact for all Blue Cross and Blue Shield claims submissions, payments, adjustments, services and inquiries (unless otherwise instructed by Arkansas Blue Cross or another Blue Plan).

Contact Information

Or visit the BlueCard Doctor and Hospital Finder.

Out-of-state Medicare Advantage Private Fee-for-Service Plans

If you provide health-care services to a member of another Blue Plan’s Medicare Advantage private fee-for-service (PFFS) plan, you do so under that Blue Plan’s Terms and Conditions. Medicare Advantage PFFS Terms and Conditions may vary for each Blue Cross and/or Blue Shield plan, and we advise you to review the Terms and Conditions before providing services to Medicare Advantage PFFS plan members from out of state.

View Terms and Conditions for out-of-state Medicare Advantage private fee-for-service plan members.

Frequently Asked Questions (FAQ)

What services and products are covered under BlueCard?

BlueCard applies to inpatient, outpatient and professional services. BlueCard does not yet apply to the following:

• Stand-alone dental and prescription drugs;
• Vision and hearing;
• Medicare supplemental;
• Federal Employee Program (FEP).

How do I identify BlueCard members?

When members from other Blue Cross and Blue Shield Plans 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 alpha prefix and, for eligible PPO members, the "PPO in a suitcase" logo.

Alpha Prefix

The three-character alpha prefix at the beginning of the member's identification number is the key element used to identify and correctly route out-of-area BlueCard claims. The alpha prefix identifies the Blue Cross and Blue Shield company ("Plan") or national account to which the member belongs.

There are two types of alpha prefixes: Plan-specific and account-specific.

Plan-specific alpha prefixes are assigned to every Plan and start with X, Y, Z or Q. The first two positions indicate the Plan to which the member belongs, while the third position identifies the product in which the member is enrolled.

• First character: X, Y, Z or Q
• Second character: A-Z
• Third character: A-Z

Account-specific prefixes are assigned to centrally processed national accounts. National accounts are employer groups that have offices or branches in more than one area but offer uniform coverage benefits to all of their employees. Account-specific alpha prefixes start with letters other than X, Y, Z or Q. Typically, a national-account alpha prefix will relate to the name of the group. All three positions are used to identify the national account.

International alpha prefixes can be seen on identification cards from foreign Blue Cross and Blue Shield members. These ID cards will also contain three-character alpha prefixes. For example, JIS indicates Blue Cross and Blue Shield of Israel members. The BlueCard claims process for international members is the same as that for domestic Blue Cross and Blue Shield members.

What is the "PPO in a suitcase" logo?

You'll immediately recognize BlueCard PPO members by the special "PPO in a suitcase" logo on their membership card. BlueCard PPO members are Blue Cross and Blue Shield members whose PPO benefits are delivered through the BlueCard Program. It is important to remember that not all PPO members are BlueCard PPO members, only those whose membership cards carry this logo. Members traveling or living outside of their Blue Plan's area receive the PPO level of benefits when they obtain services from designated PPO providers.

What about identification cards with no alpha prefix?

Some identification cards may not have an alpha prefix. This may indicate that the claims are handled outside the BlueCard program. Look for instructions or a telephone number on the back of the member's ID card for information on how to file these claims.

It is very important to capture all ID-card data at the time of service. This is critical for verifying membership and coverage. We suggest that you make copies of the front and back of the ID card and pass this key information on to your billing staff. Do not make up alpha prefixes.

If you are not sure about your participation status (PPO or non-PPO), call Arkansas Blue Cross and Blue Shield.

How do I find out about the member's eligibility?

Call 1-800-676-BLUE (2583).
With the member's most current ID card in hand, you can check available membership and coverage information by calling BlueCard Eligibility® at 1-800-676-BLUE (2583). An operator will ask you for the alpha prefix on the member's ID card and will connect you to the appropriate membership and coverage unit at the member's Blue Cross and Blue Shield Plan.

If you are unable to locate an alpha prefix on the member's ID card, check for a telephone number on the back of the ID card.

What about utilization review (precertification/preauthorization)?

Providers should remind patients from other Blue Plans that they are responsible for obtaining precertification or preauthorization for coverage of their services from their Blue Cross and Blue Shield Plan. You also may choose to contact the member's Plan on behalf of the member. If you choose to do so, refer to the precertification or preauthorization phone number on the back of the member's ID card.

The Arkansas Blue Cross Coverage Policy is available on the Provider page of this Web site.

Where and how do I submit BlueCard claims?

If you are an Arkansas provider, always submit BlueCard claims electronically through AHIN or mail to Arkansas Blue Cross and Blue Shield, P.O. Box 2181, Little Rock, AR 72203-2181. The only exception to this is if you contract with the member's Plan (for example, in contiguous counties or overlapping service areas), in which case you should file the claim directly to the member's Plan.

Be sure to include the member's complete ID number when you submit the claim. The complete ID number includes the three-character alpha prefix. Do not make up alpha prefixes. Incorrect or missing alpha prefixes and member identification numbers delay claims processing.

After Arkansas Blue Cross receives a claim, it will electronically route the claim to the member's Blue Cross and Blue Shield Plan. The member's Plan then processes the claim and approves payment or provides an explanation why a service is not covered, and Arkansas Blue Cross will remit payment based on the Arkansas Blue Cross applicable fee schedule, and the member’s benefits from the other Blue Plan or provide information as to why the service was not eligible.

If you are a non-PPO (traditional) provider and are presented with an identification card with the "PPO in a suitcase" logo on it, you should still accept the card and file with your local Blue Cross and Blue Shield Plan. You will still be given the appropriate traditional pricing and the applicable member benefits from the other Blue Plan.

The claim submission process for international Blue Cross and Blue Shield members is the same as for domestic Blue Cross and Blue Shield members.

How do indirect, support or remote providers file BlueCard claims?

If you are a health-care provider who offers products, materials, informational reports and remote analyses or services and are not present in the same physical location as a patient, you are considered an indirect, support or remote provider. Examples include, but are not limited to, prosthesis manufacturers, durable medical equipment suppliers, independent or chain laboratories or telemedicine providers.

• If you have a contract with the member's Plan, file with that Plan;
• If you normally send claims to the direct provider of care, follow normal procedures;
• If you do not normally send claims to the direct provider of care and you do not have a contract with the member's Plan, file with your local Blue Cross and Blue Shield Plan.

When and how will I be paid for BlueCard claims?

In some cases, a member's Blue Cross and Blue Shield Plan may suspend a claim because medical review or additional information is necessary. When resolution of claim suspensions requires additional information from you, Arkansas Blue Cross may either ask you for the information or give the member's Plan permission to contact you directly.

Whom do I call about claims status, adjusting BlueCard claims and resolving other issues?

or

Contact your regional office.

How do I handle calls from members and others regarding claims status or payment?

If a member contacts you, tell the member to contact their Home Blue Cross and Blue Shield Plan. Refer them to the front or back of their ID card for a customer-service number.

The member's Home Plan should not be contacting you directly. However, if the member's Plan does ask you to send them another copy of the member's claim, refer them to Arkansas Blue Cross toll free at 1-800-800-4298.

Special Note:

Even though Arkansas Blue Cross and Blue Shield will serve as your sole point of contact for BlueCard claims, please understand that this does not mean that Arkansas Blue Cross and Blue Shield assumes the obligation to pay or guarantee payment of any claims for services to the members of other Blue Cross and Blue Shield Plans, i.e., the Home Plans. Sole responsibility for payment of all BlueCard claims for members covered by other Blue Cross and Blue Shield Plans (non-Arkansas Blue Cross and Blue Shield BlueCard members) shall remain at all times with the applicable Blue Cross and Blue Shield Plan, i.e., the Home Plan. Arkansas Blue Cross and Blue Shield acts merely as the Host Plan for purposes of facilitating ease-of-service to the Home Plan’s members, and assisting in your communications with that Home Plan.

All coverage determinations for non-Arkansas Blue Cross and Blue Shield BlueCard members are the responsibilities and decisions of the Home Plan, not Arkansas Blue Cross and Blue Shield. Providers agree to look solely to the Home Plan for non-Arkansas Blue Cross and Blue Shield BlueCard members for payment with respect to any services to such members.

Please note that Arkansas Blue Cross and Blue Shield does not share ownership or governance with any other Blue Cross and Blue Shield Plan; Arkansas Blue Cross and Blue Shield is an entirely independent, separate not-for-profit mutual insurance company, organized in the State of Arkansas and owned by its policyholders. The only association between Arkansas Blue Cross and Blue Shield and other Blue Cross and Blue Shield Plans is that each separate company has been licensed by the Blue Cross and Blue Shield Association to use the registered “Cross” and “Shield” service marks in their separate business operations.

The BlueCard Program is a cooperative effort among these separate, independent licensees of the Blue Cross and Blue Shield Association but it does not in any way obligate Arkansas Blue Cross and Blue Shield to fund any benefits or become liable for any activities or omissions of any other Blue Cross and Blue Shield Plan. If you dispute the coverage or payment determination of another Blue Cross and Blue Shield plan, you must pursue appeals or other legal remedies with the applicable Blue Cross and Blue Shield Home Plan, not with Arkansas Blue Cross and Blue Shield.

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