| Q. | Does Verification apply to BlueCard? |
| A. | No |
| Q. | In an emergency, if a member’s ID card is not available can we call BCBSTX for the three-character prefix? |
| A. | No. Unfortunately, BCBSTX does not maintain membership information for out-of-state plans. You would need to contact the patient or employer group for claim filing information. |
| Q. | Is there a certain three-character prefix to designate a traditional BlueCard member? |
| A. | No. The three-character prefix is assigned to multiple BCBS plans and there is not a specific prefix to designate traditional plan members. |
| Q. | Where do we send an appeal for a BlueCard claim? |
| A. | (BlueCard) out-of-state appeals should be filed to the same address that the claim was filed. Generally, Texas Providers send appeals to BCBSTX and will coordinate with the members plan. |
| Q. | Where do I send an out-of-state claim when the ID card does not have a three-character prefix? |
| A. | You would need to contact the patient or employer group for claim filing information. |
| Q. | Why do some BCBS member’s ID cards reflect a suitcase and some do not? |
| A. | If an ID card reflects a suitcase with PPO on the inside, it generally means the member is enrolled in a PPO plan. In order for them to obtain the highest level of benefits, they would need to seek services from an in-network Physician. All non-PPO BlueCard member ID cards must include the designated blank suitcase logo. |
| Q. | Who is responsible for benefit determinations? |
| A. | The member’s BCBS plan will notify BCBSTX on how to apply the member’s benefits to the claim. |
| Q. | Why don’t (BlueCard) out-of-state claims go directly to the member’s plan? |
| A. | By filing with your BCBSTX plan, this enables the member to obtain their maximum benefits while allowing the provider to receive their contracted rate. |
| Q. | Is BlueCard a different entity? |
| A. | No. BlueCard is a program of the BlueCross BlueShield Association. |
| Q. | How do I know what the benefits are for (BlueCard) out-of-state claims? |
| A. | As with any member, benefits should be obtained prior to providing services. For (BlueCard) out-of-state members you should call 1-800-676-BLUE (2583), voice the three-character prefix at which time you will be transferred to the member’s plan where they can disclose the member’s eligibility and benefits. |
| Q. | When we call BCBSTX for claim status and they are unable to assist, where do we call? |
| A. | If your claim was filed to BCBSTX, most inquiries will be handled by the Texas Provider Customer Service Department. |
| Q. | Do I file all claims to BCBSTX? |
| A. | Yes, unless advised otherwise when obtaining eligibility and benefits. |
| Q. | Why do I receive Provider Claim Summaries advising me to send my claim to the member’s BCBS plan? |
| A. | At times BCBSTX is unable to process the claim through the (BlueCard) out-of-state program, and it must be filed directly to the member’s BCBS plan. Generally, BCBSTX will manually forward your claim to the appropriate BCBS plan. You may contact BCBSTX to establish if your claim was forwarded. |
| Q. | Is the current remittance based on our BCBSTX contract? |
| A. | Yes |
| Q. | Is there something on the (BlueCard) out-of-state ID card to determine if the member is an HMO, PPO, or Traditional member? |
| A. | For PPO members, the letters “PPO” will appear inside the suitcase. Most other products (POS, HMO or Traditional) will reflect an empty suitcase logo on the ID card. |
| Q. | Which claims are mailed to the Dallas address? |
| A. | All claims should be filed electronically when possible. All paper claims should be mailed to the Dallas address unless instructed by the member’s BCBS plan to file directly to them. |
| Q. | What is the Dallas address where claims need to be filed? |
| A. | BCBSTX, P.O. Box 660044, Dallas, TX 75266-0044 |
| Q. | What number do I call for In-Patient authorization? |
| A. | The phone number on the back of the member’s ID card. |
| Q. | Is there a list of groups or states that require filing claims to out of state plans? |
| A. | For members without an three-character prefix, follow the claim filing instructions on the back of the member’s ID card. |
| Q. | Can a secondary COB BlueCard claim be filed directly to BCBSTX? |
| A. | Yes |
| Q. | Are (BlueCard) out-of-state claims subject to the Texas Prompt Pay Legislation? |
| A. | No |
| Q. | When Specialty Care Providers are involved, and the member’s plan is out-of-state, who should be contacted for claims assistance? |
| A. | Contact the Provider's servicing plan for assistance and/or direction. |
| Q. | Is a three-character prefix used across the board? |
| A. | It is unique. Each plan that participates in the (BlueCard) out-of-state program is assigned prefixes by the Blue Cross Association (BCA). |
| Q. | Do all Texas members have three-character prefixes? |
| A. | Yes |
| Q. | If the Patient’s ID card does not have an three-character prefix what should we do? |
| A. | Make sure you have the most current copy of the member’s ID card. Usually, there are filing instructions on the back of the ID card. If not, contact the Provider Customer Service Department at the telephone number found on the member’s ID card. |
| Q. | How long should a BlueCard appeal take? |
| A. | (BlueCard) out-of-state appeals generally are handled in the same time frame as a BCBSTX claim appeal. |
| Q. | On (BlueCard) out-of-state claims where Medicare is primary, should I file directly with BCBSTX? |
| A. | Yes, all secondary (BlueCard) out-of-state claims, including secondary to Medicare, may be filed directly to BCBSTX. However, Medicare secondary claims should only be filed after confirmation that the claim was not included in the Medicare crossover process. |
| Q. | Does the three-character prefix need to be in all caps when submitted on the claim? |
| A. | It is recommended to use the ID number exactly as it appears on the member’s ID card. Texas does accept either caps or lower case. |
| Q. | If BCBSTX can identify plans and claims, why can’t BCBSTX publish a list of three-character prefixes? |
| A. | Changes and updates are periodically made to the three-character prefixes assigned to the various BCBS plans. It is extremely important to utilize the most current information at all times. |
| Q. | Does BCBS have 4 digit prefixes? |
| A. | No. Prefixes will always be three digits. |
| Q. | Are (BlueCard) out-of-state claims forwarded to the member’s benefit plan electronically or via paper? |
| A. | Claim information is transmitted to a member’s plan electronically. In addition, BCBSTX can submit electronic inquiries on behalf of our providers to the member’s plan. |
| Q. | We have a previous claims inquiry and a Provider Claim Summary in hand. The automated system states there is no claim on file for this patient. What should we do? |
| A. | The automated (VRU) system has been recently enhanced to include more (BlueCard) out-of-state claims. If the VRU is unable to locate the claim you should opt out to speak with a Provider Customer Service Representative who can assist you. |
| Q. | Why are checks for (BlueCard) out-of-state adjustments never issued? |
| A. | (BlueCard) out-of-state adjustment payments should be generated in the same manner as an original claim or any other Texas adjusted claim payment. |
| Q. | Can eligibility for (BlueCard) out-of-state members be obtained on-line? |
| A. | No. Information for out-of-state members is not currently available at the BCBSTX web site. |
| Q. | BCBSTX is moving away from using the member’s Social Security number as an identifier. Are other states doing the same? |
| A. | Yes. All BlueCross BlueShield plans have replaced their member’s Social Security number with a Unique Identifier. |
| Q. | There is a problem with out-of-state claims having different denial codes than BCBSTX supplies. |
| A. | BCBSTX is currently addressing this issue and will provide updates in future editions of the Blue Review Quarterly Newsletter. |
| Q. | When I call 1-800-676-BLUE, I always get transferred? Why can’t I be given the telephone number instead? |
| A. | Calls are answered in a central office and transferred to the actual plan based on the three-character prefix provided. |
