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.