BlueCard is a national program that enables members to obtain health care services while traveling or living in another Blue Cross and/or Blue Shield Plan’s (Blue Plan’s) service area. It applies to all covered inpatient, outpatient and professional health care services. The program links participating health care providers with Blue Plans across the country through a single electronic network for claims processing and reimbursement. Follow this link to view other Blue Plan's medical policy or general precertification/preauthorization information.
Here are five easy steps to follow when you provide services to a BlueCard member. For detailed information, refer to the BlueCard Program Manual.
1. Check the member’s identification (ID) card for the suitcase logo and alpha prefix
A ”suitcase” logo on the member’s ID card indicates the BlueCard Program applies.
Note: If there is no suitcase logo, call BlueCard Eligibility to verify whether the BlueCard Program applies (see step 2).
A “PPO” inside the suitcase logo indicates the member is enrolled in either a PPO or EPO product. These members use the PPO network for the highest benefit level and lowest out-of-pocket costs; in Florida that is Florida Blue's Preferred Patient Care (PPC) network or in limited circumstances, the NetworkBlue network. PPO BlueCard members may also use the Traditional/PPS/PHS network, but will usually have higher out-of-pocket costs. Please note, however, that EPO products may have limited benefits out-of-area. Refer to the member’s ID card for information.
An empty/blank suitcase logo indicates the member is enrolled in a Traditional, POS or HMO product. These members use Florida Blue’s Traditional/ PPS/PHS network.
An alpha prefix (three letters at the beginning of the ID number) identifies the member’s Blue Plan or national account. The alpha prefix is followed by 9-17 numbers or a combination of letters and numbers (e.g., ABC1234A560789, ABCD1234567899876).
Note: If there is no alpha prefix, this indicates that claims and other transactions are handled outside the BlueCard Program. Look for filing instructions or a telephone number on the ID card.
2. Verify eligibility and benefits
You can verify eligibility and benefits in one of two ways:
- Use Availity to submit an electronic inquiry. Submit the complete ID number with alpha prefix; do not include spaces or hyphens.
- Hours of operation for other Blue Plans may vary. For Blue Plans that operate in real-time, the response time typically will be less than one minute.
- The following minimum information will be returned: patient name, date of birth, gender, insurance type code (i.e., PPO, HMO), effective date, coinsurance (in- and out-of-network), copay and deductible (annual static value only). Whether additional information is returned depends on the other Blue Plan.
Alternative Networks/ Alt Net
Although most Blue Card members with the PPO suitcase access the PPC network, there are a few national accounts that access NetworkBlue. You can identify these BlueCard members by ‘NetworkBlue’ on the front of their ID card and in the Plan Coverage Description field of Availity. The In Network Lab for NetworkBlue members is Quest Diagnostic and Dermpath Diagnostics. The preferred lab for anatomical pathology services in Florida is AmeriPath Diagnostics. In the event labs are taken at the provider’s office, the provider must send the labs to Quest in order for the labs to be covered at the in-network level of benefits.
- Call the BlueCard Eligibility line at (800) 676-BLUE (2583). You will be asked for the alpha prefix on the ID card to be routed to the member’s home plan. You may inquire about:
- Eligibility and benefits.
- Whether the BlueCard Program applies to the member. (There are a few exempt groups.)
- Precertification and referral authorization requirements.
Note: For claim-related information, do not call BlueCard Eligibility; call Florida Blue at (800) 727-2227.
3. File BlueCard claims to Florida Blue
All claims for BlueCard members should be filed to Florida Blue. Submit the complete member ID number including the alpha prefix. BlueCard claim processing by Florida Blue is based on eligibility, benefit and medical coverage guideline information from the member’s Blue Plan. File the claim electronically or send a paper claim to:
P.O. Box 1798
Jacksonville, FL 32231-0014
You contract with a Blue Plan in a contiguous state – Providers who are located near the border of Florida may contract with Florida Blue and a Blue Plan in an adjoining state. When you contract directly with the member’s Plan of a contiguous state, file the claim to that Plan.
- Select ancillary providers (lab, durable medical equipment, home health and specialty pharmacy) with remote contracts – Refer to the BlueCard Program Manual for claim filing guidelines.
Medigap Claims (Medicare Complementary/Supplemental Standard A-J policies)
File the claim to your Medicare carrier for primary payment. Include the member’s Blue Plan five-digit Medigap insurer ID number, not Florida Blue’s. The claim will normally be electronically forwarded to the member’s supplement Plan for processing of secondary benefits. Check the Medicare Remittance Notice to determine if the claim crossed over.
- If the claim crossed over correctly to the member’s Blue Plan, no action is required.
- If the claim did not cross over correctly to the member’s Blue Plan, file a paper claim to Florida Blue with the Medicare Remittance Notice attached. Florida Blue will route the claim to the member’s Blue Plan for processing and payment. (Florida Blue does not process the claim.)
When you provide services to a member who has coverage with another Blue Plan but the BlueCard Program does not apply, file the claim to Florida Blue as long as the member ID number includes an alpha prefix. The following products and groups are excluded from the BlueCard Program:
- Stand-alone dental
- Federal Employee Program (FEP)
- Medicare Advantage Plans (HMO, PPO*, PFFS, POS, MSA)
*Exception: Medicare Advantage PPO Network Sharing Program (refer to the BlueCard Program Manual for details).
4. Contact Florida Blue for claim inquiries
Florida Blue is your single point of contact for all claim inquiries including claim status, problem resolution and claim adjustment inquiries. Check BlueCard claim status online using the Availity or call our Provider Contact Center at (800) 727-2227.
5. Do not balance bill
You may bill the BlueCard member for any deductible, copay, coinsurance or non-covered amounts. Participating physicians and providers accept the contractually agreed-upon allowance and may not balance bill the member for the difference between their standard charge and contractual allowance.