What is the BlueCard Program?
The BlueCard® Program links participating healthcare providers and the independent Blue Cross and Blue Shield Plans across the country and abroad with a single electronic network for claims processing and reimbursement. We encourage you to use the information and tools in this section to submit claims to Blue Shield of California when a Blue plan member insured from another state seeks medical care from your office or facility.
Can providers who do not participate in the Blue Shield of California network submit claims?
California providers who do not participate in the Blue Shield of California network may also send their claims to us; however, these providers may not receive in-network reimbursement from their local Blue plan and may still be required to bill the patient.
What are the advantages of the BlueCard Program?
The BlueCard Program allows California providers to submit claims to Blue Shield of California for processing, in accordance with their agreement as a contracted provider.
How do I identify Blue Plan members?
Blue Plan members are easily identified by their identification cards. Ask to see the member’s ID card at each visit and share this information with your billing staff. Review these ID cards for the telephone number of the member’s Blue plan, as well as for claim filing addresses or other instructions.
There are three ID card elements you should look for to identify a Blue Plan member:
- Plan logo: The presence of another Blue Cross and/or Blue Shield’s plan logo on the member’s ID card is the first visual indicator that a member may be eligible for benefits.
- Three-character prefix: The three-character prefix on the member’s ID card is the key element used to identify the member's Blue plan and to correctly route claims. It is necessary to confirm membership, eligibility and coverage. If there is no prefix on a member’s ID card, that member is not eligible for benefits through the BlueCard Program.
- Suitcase logo: Blue Plan members whose ID cards display the PPO in the suitcase logo are enrolled in Preferred Provider Organization (PPO) products. Benefits are delivered through the BlueCard Program. Members traveling or living outside their plan’s service area receive PPO-level benefits when they need services from participating physicians and other healthcare professionals. Members whose ID cards display the blank suitcase logo are enrolled in a product other than PPO. These members may also be eligible for BlueCard processing. Members whose ID cards do not display a suitcase logo are excluded from receiving benefits through the BlueCard Program.
How do I submit BlueCard claims?
Providers who participate in the Blue Shield of California network should submit BlueCard claims electronically. Use our Claims Routing Tool to find out where to send your claims.
How are BlueCard claims processed?
Once we receive your BlueCard claim, we will electronically route it to the member's Blue plan that will process the claim according to the member's benefits contract. They will then authorize us to process the claim according to your local Blue Shield of California contract. Please be certain to submit the claim with the appropriate prefix.
How is the BlueCard Program administered?
Blue Cross and Blue Shield national network of providers serve more than 100 million members nationwide. We understand the importance of ensuring easy administration, and we want your patients to have a positive experience with each visit.
- Are there additional provider resources for the BlueCard Program?
Whom do I contact for information on a BlueCard claim?
For BlueCard claims status and claims-related questions, Blue Shield of California’s claims team can be reached at (800) 622-0632. Online claims status is available at Check claim status | Blue Shield of CA Provider (blueshieldca.com).
Are there BlueCard exclusions?
The following services cannot be submitted through the BlueCard Program and must be submitted directly to the member's plan:
- Stand-alone dental coverage
- Stand-alone prescription drug coverage
Also, certain independent clinical labs, durable/home medical equipment, orthotic/prosthetic providers and specialty pharmacies must submit claims according to the ancillary claims filing requirements. More information about the ancillary claims filing requirements for these provider types can be found by logging in to Provider Connection and visiting the Ancillary claims filing guidelines page.
Whom do I contact for pre-certification of services for Blue plan members whose Blue plan is based in a state other than California?
Once you are logged in to Provider Connection, the online EPA tool enables you to access another state’s Blue plan provider portal to request electronic pre-service review and authorization approvals through a secure routing mechanism. On our EPA page, you have the options to seek:
- Medical Policy Information – select this option to obtain medical policy for a service
- Prior Authorization Information – select this option to determine if pre-service and pre-authorization is required for a service
- Electronic Provider Access – select this option to submit a pre-certification and prior authorization request
Are prefixes required when submitting BlueCard claims?
Three-character prefixes are required when submitting BlueCard claims. The prefix on the Blue Plan member's ID card is the key element used to identify the Blue plan to which the member belongs and to correctly route claims.
- How to verify eligibility and benefits for other state Blue plan members?
How can I get assistance with payment issues for secondary Medicare claims?
Call Blue Shield of California’s Claims team at (800) 622-0632. A representative will assist you with secondary Medicare claims involving other Blue plans. Our experienced BlueCard representatives will work directly with the member’s Blue plan, on your behalf, until your questions are resolved.