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71 11/2005
BlueCard Program
The Blue Cross and Blue Shield Association’s BlueCard program allows physicians to
file inpatient, outpatient, and professional claims with BCBSGa for members who are
covered by other Blue Cross and/or Blue Shield plans. Through a single electronic
network for claims processing and reimbursement, this program links physicians with
other Blue Cross and Blue Shield plans across the country. BCBSGa remains the sole
contact for claims submissions, payments, adjustments, services, and inquiries about
the BlueCard program.
Here’s how the BlueCard program works:
• A member visits the physician’s office and presents an ID card with a blank
suitcase logo. (Not all PPO members are BlueCard members – only those whose
membership card displays the suitcase logo.)
• Look for the three-character alpha prefix that precedes the ID number on the
card. The alpha prefix shows the patient is a member of the BlueCard program
and identifies his or her plan or national account. This information is important
to routing out-of-area claims.
• Once the alpha prefix is identified, member eligibility may be verified via
www.bcbsga.com, on the Provider Access page, under Eligibility. The alpha
prefix, member ID number, and date of birth are required. See the Provider
Access section of this manual for more details.
• Eligibility can also be verified by calling 1-800-676-BLUE (2583) from 8 AM to
10 PM. The alpha prefix and member ID number are required, and alpha
characters must be converted to numbers for entry. If there is no alpha prefix,
the member’s claims are handled outside the BlueCard program.
• BlueCard out-of-area members are responsible for obtaining pre-authorization
from their own Blue Cross and/or Blue Shield plan.
• Once the member receives care, his or her claim should be submitted to
BCBSGa. Again, the alpha prefix and complete ID number are required.
Incorrect or missing alpha prefixes and member ID numbers delay claims
processing.
• When BCBSGa receives the claim, it is electronically routed to the member’s Blue
Cross and/or Blue Shield plan. The member’s plan processes the claim and
approves payment. BCBSGa then pays the physician according to his or her
contract.