​BlueCard® Medicaid claims cannot be processed without complete information

August 13, 2020

BlueCard program

We regularly publish information about the BlueCard program in Partners in Health UpdateSM. To reference BlueCard rules and requirements, please visit our dedicated BlueCard page. If you have questions about the BlueCard program, email us at provcommrequests@ibx.com.

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 (i.e., Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) for treatment.

Independence coordinates with other Blue Plans to process professional and institutional electronic billing for Host claims. We strive to pay claims in a timely manner, but missing details in a claim submission can delay the payment process or cause a claim rejection.

Common reasons for claim rejections

Be sure to complete all information fields in the claim. The claim cannot be processed if it is missing:

  • actual ambulance mileage;
  • attending physician information, including:
    • name;
    • National Provider Identifier (NPI);
    • tax ID;
    • physical address;
    • specialty (claims will process at a higher copay if missing);
  • medical record number;
  • name, dosage, and National Drug Code number;
  • occurrence date or from and to date, code, and span code;
  • operating physician number and qualifier;
  • referring physician information, including name and NPI number (when place of service is home, diagnostic, or outpatient radiology services);
  • service facility location state and ZIP code;
  • value amount and code.

More information

If you have questions about electronic claim submission guidelines, refer to the Independence Blue Cross HIPAA Transaction Standard Companion Guide, available on the Trading Partner Business Center. 

For more information about the BlueCard Program, visit the BlueCard section or email us at provcommrequests@ibx.com.

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.