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BlueCard

BlueCard® PPO Host claim submission made simple  

January 15, 2019    

Through the BlueCard Program, providers can render services to patients who are enrolled in a Blue Cross® and Blue Shield® Plan – other than one offered by Independence – and patients can visit physicians or facilities within the Independence five-county service area for treatment.  

There are two BlueCard PPO networks within the Independence five-county service area (Bucks, Chester, Delaware, Montgomery, and Philadelphia counties in Pennsylvania):

  • Personal Choice® (Independence’s PPO network)
  • Premier Blue (Highmark Blue Shield’s [Highmark] PPO network)

PPO professional providers

PPO professional providers in the five-county network should submit BlueCard claims to the Plan with which they have a contract. A provider who contracts with both networks can choose to submit to either Highmark or Independence, excluding those claims for Highmark or Independence members.

If a provider contract exists with one Plan and not the other, the claim must be submitted to the Plan that holds the member’s coverage, regardless of their participation status with that Plan.

Networks Provider’s contract plan Member’s coverage plan Provider filing instructions

Professional PPO

Independence, Highmark, and Capital Blue Cross

Capital Blue Cross

The provider must submit the claim to Capital Blue Cross, the plan who holds the member’s coverage.

Independence and Highmark

Capital Blue Cross

The provider can choose to submit to either Independence or Highmark since they are not contracted with the members coverage plan.

Independence and Highmark

Independence

The provider must submit the claim to Independence, the plan who holds the member’s coverage.

Independence and Highmark

Highmark

The provider must submit the claim to Highmark, the plan who holds the member’s coverage.

Highmark

Independence

The provider must submit the claim to Independence, the plan who holds the member’s coverage.

Independence

Highmark

The provider must submit the claim to Highmark, the plan who holds the member’s coverage.

PPO facility providers

Facility providers in the five-county service area who are contracted with Independence, should submit BlueCard claims to Independence for adjudication. Unlike with PPO professional claims, the member’s coverage plan does not impact which plan the claim is submitted to for a facility claim.

All members are subject to eligibility verification and the applicable precertification requirements of their Home Plan.

For more information

If you have any questions about submitting BlueCard PPO host claims, contact us via email at specialistsrequests@ibx.com or facilityancillaryrequests@ibx.com, as appropriate to your provider type. Please include “BlueCard PPO host claims” in the subject line of the email.





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