BlueCard is a national program offered through the Blue Cross and Blue Shield Association (BCBSA), an association independent of Blue Cross® and Blue Shield® Plans, which enables members of one Blue Plan to obtain health care benefits and services while traveling or living in another Blue Plan's service area.
The BlueCard program provides coverage for members by linking participating health care providers through a single electronic network for claims processing and reimbursement. This extensive network provides coverage to members travelling in the U.S. and approximately 170 countries and territories worldwide.
Claims for independent clinical laboratories (lab), durable/home medical equipment and supply (DME/HME) providers, and specialty pharmacies
must be filed to the local Plan in the service area where the ancillary services are deemed rendered.
The claims will be processed based on the contractual relationship between the ancillary provider and the local Plan.
The Local Plan is defined as follows for ancillary services:
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Lab: The Plan in the service area the referring provider is located.
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DME/HME: The Plan in the service area the equipment was shipped to or purchased at a retail store.
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Specialty Pharmacy: The Plan in the service area the ordering physician is located.
Note: These billing guidelines do not apply to claims submitted for Federal Employee Program (FEP®) members. For more information about FEP claims filing guidelines, please refer to the
FEP website.
Billing guidelines for ancillary providers contracted with Independence Blue Cross (IBX)
Lab (non-hospital based):
Referring Provider:
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Field 17 with qualifier DN on CMS-1500 form, or
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Loop 2310A (claim level) on 837P (Professional Electronic Submission)
| File the claim with the Plan in the service area where the
referring provider is located, regardless of where the specimen was drawn.
|
DME/HME:
Patient's Address: -
Field 5 on CMS-1500, or
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Loop 2010CA on 837P
Ordering Physician: -
Field 17 with qualifier DK on CMS-1500, or
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Loop 2420E (line level) on 837P
Place of Service: -
Field 24B on CMS-1500, or
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Loop 2300, CLM05-1 on 837P
Service Facility Location Information: -
Field 32 on CMS-1500, or
-
Loop 2310C (claim level) on 837P
| File the claim with the Plan local to the service area in which the DME/HME supplies were shipped or received. Exceptions:
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For a Highmark member, the DME/HME supplier must file the claim with Highmark, if DME supplies are delivered in the five-county service area.
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For an IBX member where the DME/HME supplier is contracted with IBX, and DME/HME supplies are delivered in one of the contiguous counties, the claim must be filed with IBX. If outside of the IBX service area (five-county or contiguous counties), the claim must be filed with the local plan where the supplies are being delivered.
|
Specialty Pharmacy (non-routine, biological therapeutics ordered by a health care professional as a covered medical benefit as defined by the Plan’s Specialty Pharmacy formulary):
Referring Provider:
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Field 17B on CMS-1500 form, or
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Loop 2310A (claim level) on 837P
| For states with multiple Blue Plans, file the claim with the Plan local to the state or county of the ordering physician.
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For more information about the BlueCard Program, visit the Products section and select BlueCard from the TAG drop-down menu.
Independence Blue Cross and Highmark Blue Shield are independent licensees of the Blue Cross and Blue Shield Association.
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