BlueCard® PPO Professional Host claim submissions

June 1, 2016

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Through the BlueCard Program, providers can render services to patients who (1) are enrolled in a Blue Cross® and Blue Shield® plan other than one offered by Independence and (2) present to physicians in the Independence five-county service area (i.e., Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) for treatment.

There are two BlueCard PPO professional networks within the Independence five-county service area:

  • Personal Choice® (Independence?s PPO network)
  • Premier Blue (Highmark Blue Shield?s PPO network)

Professional providers who are contracted with both of these PPO networks may submit claims to either Independence or Highmark Blue Shield, except for the following:

  • Providers who hold a professional contract with Independence and not Highmark Blue Shield should submit professional claims to Independence directly.
  • Providers should continue to submit professional claims to Highmark Blue Shield for Traditional Indemnity members and HMO members (for urgent/emergent situations) enrolled in a Blue Cross and Blue Shield plan other than one offered by Independence.
  • Professional providers who are contracted with other area health plans (e.g., Highmark Blue Shield, Highmark Blue Cross Blue Shield of Delaware, Capital Blue Cross, Horizon Blue Cross Blue Shield of New Jersey) must submit claims to the applicable contracted health plan when treating members from those plans.

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

If you have any questions related to this article, please contact your Network Coordinator.

Updated Payer ID grids available soon

The Payer ID grids will be updated in early June based on the information in this article. You will be able to download the latest versions from our Electronic Data Interchange (EDI) webpage to ensure that your office is using the most up-to-date information for claim submissions. Announcements will be made on Independence NaviNet® Plan Central and on our Provider News Center once the updated Payer ID grids are available.

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