Provider Manual The BlueCard Program ®

The BlueCard® Program
Provider Manual
www.bcbsla.com
Network Administration Division
Provider Communications
1.800.716.2299 phone • 225.297.2750 fax
P.O. Box 98029 • Baton Rouge, LA 70898-9029
5525 Reitz Avenue • Baton Rouge, LA 70809-3802
®
23XX4272 R06/14
®
Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company
Blue Cross and Blue Shield of Louisiana
BlueCard® Program PROVIDER MANUAL
This manual is designed to provide information to aid you in servicing members of a Blue Plan other than Blue
Cross and Blue Shield of Louisiana, (BCBSLA). These members are referred to as BlueCard members.
Periodically, we send newsletters and informational notices to providers regarding BlueCard members. Please keep
this information with this manual. Updated manuals and provider newsletters may be found on the Provider page of
our website at www.bcbsla.com/providers.
If you have questions about the information in this manual, please call Network Administration at 1.800.716.2299,
option 1 or 225.297.2758.
Please note:
This manual contains a general description of Benefits that are available subject to the terms of a Member’s contract and our
corporate medical policies. The Member Contract/Certificate contains information on Benefits, limitations and exclusions
and managed care benefit requirements. It also may limit the number of days, visits or dollar amounts to be reimbursed.
This manual is provided for informational purposes only. You should always directly verify the Blue member's benefits prior
to performing services. Every effort has been made to print accurate, current information. Errors or omissions, if any, are
inadvertent.
As stated in your agreement: This manual is intended to set forth in detail BlueCard services and policies. BCBSLA retains
the right to add to, delete from and otherwise modify The BlueCard Program Provider Manual as needed. This manual and
other information and materials provided by BCBSLA are proprietary and confidential and may constitute trade secrets of
BlueCard Plans and/or BCBSLA.
Website/Email
Call/Fax
87 '
7
Mail
,
Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company
P.O. Box 98029, Baton Rouge, Louisiana 70898-9029 • 1.800.716.2299
Table of Contents
What is the BlueCard® Program? 1
How the BlueCard Program Works
1
What are the advantages of participating in the BlueCard Program? 2
What services or products are covered under the BlueCard Program? 2
How do I identify BlueCard members?
3
Medical Policy, Pre-Authorization and Pre-Certification Router
4
Consumer-Directed Healthcare
5
Consumer-Directed Health Plans
Members with Consumer-Directed Health Plans Like Blue Saver
5
7
Limited Benefit Products
7
Coverage and Eligibility Verification
8
Provider Financial Responsibility
8
Verifying Eligibility
8
Utilization Review
8
Submitting Claims for BlueCard members
Filing Claims with Your National Provider Identifier (NPI)
Referring Physicians NPIs
Hardcopy Claims
Electronic Claims
Medicare Primary Claims Processed Through the BlueCard Program
Medicare Crossover Duplicate Claims Overpayments
Ancillary Claims (Independent Lab, Durable Medical Equipment/Home Medical Equipment, Specialty Pharmacy)
Dental and Oral Surgery Claims
ADA Claim Form
CMS-1500 and Electronic Claim Form for Dental Claims
9
9
9
9
9
9
10
11
12
14
14
14
Claims Payment
14
Appeals 14
Protocol for Providers Relations Involvement in Claims Resolution 15
Submitting BlueCard Medical Records
16
Coordination of Benefits Questionnaire 17
Medicare Advantage Members from Other Blue Plans 18
Medicare Advantage Private Fee-for-Service 19
Frequently Asked Questions 20
What is the BlueCard® Program?
BlueCard® is a national program that enables members of one Blue Cross and Blue Shield (BCBS) Plan to
obtain in-network healthcare services while traveling or living in another BCBS Plan service area. BlueCard
links participating healthcare providers with other Blue Plans across the country, and in more than 200 countries
and territories worldwide, through a single electronic network for professional, outpatient and inpatient claims
processing and reimbursement.
Through BlueCard, you can submit claims for Blue members visiting you from other areas directly to Blue Cross
and Blue Shield of Louisiana (BCBSLA). We are your sole contact for all BCBS claims submissions, payments,
adjustments, services and inquiries.
A majority of all doctors and hospitals throughout the United States contract with Blue Cross and/or Blue Shield
Plans. Outside of the United States, members have access to participating doctors and hospitals worldwide.
Not only can members take advantage of savings that BCBSLA has negotiated with providers, members do not
have to complete a claim form or pay up front for healthcare services, except for out-of-pocket expenses, such
as deductibles, copayments and coinsurance. All Blue Plans participating in the BlueCard Program must deliver
to other Blue Plans' BlueCard members the same provider discounts that they have negotiated for their own
members.
How the BlueCard Program Works
Member lives/travels in
Louisiana, but account is
headquartered in Tennessee.
Provider submits claim to
BCBS and Blue Shield of
Louisiana.*
BCBSLA forwards the claim
to BlueCross BlueShield of
Tennessee, which applies
member benefits and
processes the claim.
Member obtains names of
BlueCard PPO providers.
BlueCard Access Line
1.800.810.BLUE (2583)
Provider verifies
membership and coverage.
Use iLinkBLUE or the
BlueCard Eligibility Line
1.800.676.BLUE (2583)
Then the Tennessee Plan
issues an explanation of
benefits to the member and
routes the claim back to
BCBSLA for reimbursement.
Member receives services
from PPO provider.
Provider recognizes
BlueCard logo on the
member's ID card.
BCBSLA issues the
remittance advice and
payment to our provider.
* Some ancillary services have different filing rules. Please
reference the "Ancillary Claims" section of this manual.
Blue Cross and Blue Shield of Louisiana
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1
What are the advantages of participating in the BlueCard® Program?
The BlueCard Program lets you conveniently submit claims for members from other Blue Plans, including
international Blue Plans, directly to BCBSLA. We are your focal point for claims submissions, payments,
adjustments, services and inquiries for any BlueCard members to whom you provide services.
More than 300,000 other Blue Plans' members are currently residing in Louisiana. You have easy access to
coverage information on these members through the BlueCard Eligibility® line at 1.800.676.BLUE (2583).
The BlueCard Program’s simple billing process provides quicker payments for your services to out-of-area
patients.
What services and products are covered under the BlueCard® Program?
The BlueCard Program applies to all inpatient, outpatient and professional claims. PPO, POS and HMO products
are included in the BlueCard Program.
The following products are optional under the BlueCard Program:
• Stand-alone vision and hearing
•
Medicare supplement
The following products are excluded under the BlueCard Program:
2
•
Stand-alone dental
•
Prescription drugs
•
Federal Employee Program (FEP). FEP members have the letter “R” in front of their
member number. Please follow your FEP billing guidelines for these contracts.
•
Medicare Advantage (PPO and PFFS Plans)
Medicare Advantage is a separate program from BlueCard; however, you may see members of
other Blue Plans who have Medicare Advantage coverage. We have included a section on Medicare
Advantage claims processing in this manual.
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Blue Cross and Blue Shield of Louisiana
How do I identify BlueCard® members?
When members from other Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan
membership identification card. The main identifiers for BlueCard members are the alpha prefix, a blank suitcase logo,
and for eligible PPO members, the “PPO in a suitcase” logo.
A correct member identification number includes the three-character alpha prefix in the first three positions and
all subsequent characters for a total of 17 positions. Some member identification numbers may include alphabetic
characters within the body of the number. These alphabetic characters are part of the member’s identification number
and are not considered to be part of the three-character alpha prefix.
Alpha Prefix
The three-character alpha prefix at the beginning of the member’s identification number is the key element used to
identify and correctly route out-of-area claims. It is also critical for confirming a patient's membership and coverage. The
alpha prefix identifies the Plan or national account to which the member belongs.
It is very important to capture all identification card data at the time of service. This is critical for verifying
membership and coverage. If the information is not captured correctly, you may experience a delay in claims processing.
We suggest that you make copies of the front and back of the identification card and pass this key information on to your
billing staff and any other providers you refer the member to; e.g. lab, x-ray, etc. Do not make up alpha prefixes.
Do not assume that the member’s ID number is the social security number. All Blue Plans replaced Social Security
numbers on member ID cards with an alternate, unique identifier.
Identification Cards with no Alpha prefix
Some identification cards may not have an alpha prefix which may indicate that claims are handled outside the BlueCard
Program. Please look for instructions or a telephone number on the back of the member’s identification card for how to
file these claims. If that information is not available, call Provider Services at 1.800.922.8866.
PPO
The three-character
alpha prefix.
The "PPO in a suitcase"
logo may appear in the
lower right corner of the
ID card.
Blank suitcase logo
indicates the member
has Traditional, POS or
HMO benefits.
“PPO in a Suitcase” Logo
Blank “Suitcase” Logo
You will immediately recognize BlueCard PPO
members by the special “PPO in a suitcase” logo on
their membership identification card. BlueCard PPO
members are BCBS members whose PPO benefits
are delivered through the BlueCard Program. It is
important to remember that not all PPO members
are BlueCard PPO members, only those whose
identification cards carry this logo. BlueCard PPO
members traveling or living outside of their Blue Plan’s
area receive PPO-level benefits when they obtain
services from designated BlueCard PPO providers.
A blank “suitcase” logo on a member’s identification
card indicates that the member has Blue Cross
and Blue Shield Traditional, POS or HMO benefits
delivered through the BlueCard Program.
Blue Cross and Blue Shield of Louisiana
*Providers should verify benefits for HMO members. The
empty suitcase logo does not guarantee that the HMO
member has benefits if he or she receives services from a
participating provider in that state. Most HMO members must
get an authorization to see a provider outside of their service
area. To ensure claims are paid timely and accurately, please
use iLinkBLUE or call Provider Services at 1.800.922.8866.
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Medical Policy, Pre-Authorization, Pre-Certification Router
Louisiana and out-of-area providers have access to general medical policy and pre-authorization and pre-certification
information for other Louisiana and out-of-area members through our iLinkBLUE Provider Portal.
Note: Information is not available for Medicare Advantage or Federal Employee Program (FEP) members.
Louisiana Providers
Louisiana providers will login to iLinkBLUE and enter the member's alpha prefix into the Medical Policy Coverage
Guidelines or Pre-Authorization/Pre-Certification Information hyperlinks on the iLinkBLUE navigational menu bar. If the
patient is a BCBS of Louisiana member, the provider will retirieve general Louisiana medical policy and pre-authorization
and pre-certification information.
If the patient is an out-of-area member, the provider will connect to the member's homeplan via the iLinkBLUE website
and will retireve general medical policy and pre-authorization and pre-certification information.
Blue Cross
Contract # Search
Coverage Information
Claims Entry
Allowable Charges
Authorizations
Confirmation Reports
EFT Notifications
Remittance Advice
Blue Card - Out of Area
NPI Update
Manuals
Medicare
Medicaid
BCBSLA
Out-of-Area
Medical Policy
Coverage Guidelines
BCBSLA
Out-of-Area
Pre-Authorization/
Pre-Certification
Information
Medical Code Editing
Return to Main
•
•
Click on “BCBSLA” to search for information on BCBS and Blue Shield of Louisiana members.
Click on “Out-of-Area” to search for information for members of another Blue Plan.
Once in the tool, enter the member’s alpha prefix. The tool reads the alpha-prefix and then electronically routes the user
to the member’s Blue Plan to retrieve the general medical policy, pre-authorization or pre-certification information.
Out-of-Area Provider
Providers will connect to their local BCBS provider portal and will be routed to our iLinkBLUE Provider Portal through
a BCBS Association router. This router provides access to Louisiana medical policy and pre-authorization and precertification information.
Blue Cross and Blue Shield of Louisiana
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Consumer-Directed Health Care
Consumer-directed health care (CDHC) is a movement in the healthcare industry designed to empower members, reduce
employer costs and change consumer healthcare purchasing behavior. CDHC provides the member with additional
information to make informed and appropriate healthcare decisions through the use of member support tools, provider
and network information, and financial incentives. CDHC includes many different benefit plans and services including
consumer-directed health plans (CDHP), high deductible health plans and the option to use debit cards for payment. In
conjunction with these plans, members may have a health reimbursement account (HRA), health savings account (HSA)
or flexible spending-account (FSA).
When the consumer is paying more of the bill, you may need to devote resources to conducting pre-service work with
patients. Consumers on a high deductible health plan may require more specialized service work due to the questions on
cost and options.
When the Consumer Is Paying More of the Bill

PROVIDER
CONSUMER
Sales/ Marketing
Fulfillment
Pre-Service

At Point of Service
Post-Service
• Seeks education
about choices
• Selects health plan
• Selects network/
providers
• Seeks information
• Estimates costs to
compare providers and
treatment options
• Seeks quality
information about
providers
• Knows what they owe • Seeks help with next steps of
• Can apply payment
treatment plan
from a variety of
- Health information/ coaching
sources, including
- Efficient sources
access to credit
• Promotion to
consumers
• Performance
information for
consumers
• Determines member
eligibility and benefits
• May estimate member
responsibility for
upcoming service
• May inform member of
estimate in advance
• Determines eligibility,
benefits and
specific member
responsibility
• Collects correct
amount from the
source selected by
the member
• Provides feedback on
performance
• Seeks improvements
- Administrative
- Clinical
Consumer-Directed Health Plans
High-deductible health plans (HDHPs) partnered with member personal savings accounts (PSAs), such as a HSA, a HRA,
or a FSA, form a CDHP. The type of account used in these arrangements has strong implications to the administration of
the CDHP, as the IRS regulations governing these tax-favored PSAs vary significantly.
Once members have met their deductible, covered expenses are paid based on the member’s benefit plan. As a
participating provider, you should treat these members just as you would any other BCBS member:
• You should accept the BCBS reimbursement amount/allowable charge (up to the member’s deductible amount)
and any coinsurance amount, if applicable, as payment in full.
• If you collect billed charges up front, you must refund the member the difference between your charge and the
BCBS reimbursement amount/allowable charge within 30 days.
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Blue Cross and Blue Shield of Louisiana
Examples of what to collect from CDHP members:
1) Member’s Total Deductible $2000
Member’s Deductible Paid $2000
Allowable Charge $ 100
Amount to be collected from member
$
0
BCBS Pays$ 100
2) Member’s Total Deductible $2000
Member’s Deductible Paid $1000
Allowable Charge $ 100
Amount to be collected from member $ 100
3)
Member’s Total Deductible Member’s Deductible Paid Allowable Charge Member’s Coinsurance (20%)
Amount to be collected from member
BCBS Pays
$2000
$2000
$ 100
$ 20
$ 20
$ 80
Member Has Met Deductible
Member Has NOT Met Deductible
Member with Co-insurance
BlueCard members whose plan includes a debit card can pay for out-of-pocket expenses by swiping the card through any
debit card swipe terminal. These cards are used just like any other debit card. The funds will be deducted automatically
from the member’s appropriate HRA, HSA or FSA account. If your office currently accepts credit card payments, there is
no additional cost or equipment necessary. The cost to you is the same as the current cost you pay to accept any other
signature debit card.
Combining a health insurance ID card with a source of payment is an added convenience to members and providers.
Members can use their debit cards to pay outstanding balances on billing statements. They can also use their cards via
phone in order to process payments. In addition, members are more likely to carry their current ID cards, because of the
payment capabilities.
Below are some helpful tips that will guide you when processing claims for and payments from Blue members with a
consumer-directed health plan like BlueSaver:
• Commit to pre-service work with patients. Contact to confirm appointment and ask them to bring a copy of their
current member card. Offer to discuss out of pocket expenses prior to their visit.
• Ask members for their current member ID card and regularly obtain new photocopies (front and back) of
the member ID card. Having the current card will enable you to submit claims with the appropriate member
information (including alpha prefix) and avoid unnecessary claims payment delays.
• Verify the member’s eligibility or benefits through iLinkBLUE or by calling BlueCard Eligibility® at
1.800.676.BLUE (2583) and provide the alpha prefix, or use electronic capabilities.
• Carefully determine the member’s financial responsibility before processing payment.
• If the member presents an HSA or HRA debit card or debit/ID card, be sure to verify the member’s cost sharing or
out-of- pockets amount before processing payment.
• Please do not use the card to process full payment up front.
• File Claims for all members with CDHPs (including those with BlueCard) to BCBSLA.
If you have any questions about the healthcare debit card processing instructions or payment issues, please contact the
debit card administrator’s toll-free number on the card.
Blue Cross and Blue Shield of Louisiana
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Members with Consumer Directed Health Plans
Many CDHC members carry healthcare debit cards that allow them to pay for out-of-pocket costs using funds from their
HRA, HSA or FSA.
Some cards are "stand-alone" debit cards which cover out-of pocket costs, while others also serve as a member
identification card as they include the member's identification number. The combined card will have a nationally
recognized Blue logo, along with the logo from a major debit card company such as MasterCard® or Visa®.
Members can use their cards to pay outstanding balances on billing statements. If your office currently accepts credit card
payments, there is no additional equipment necessary. The cost to you is the same as the current cost you pay to swipe
any other signature debit cards.
If the member presents a debit card (stand-alone or combined), be sure to verify the member's cost sharing amount
before processing payment. Do not use the card to process full payment up front.
You may check CDHC members’ benefits and eligibility online by accessing iLinkBLUE or by calling Provider Services at
1.800.922.8866.
Sample:
stand-alone
healthcare
debit card
Sample:
combined
healthcare
debit card
and member
ID card
Limited Benefit Products
InReach or MyBasic
Verifying Blue members’ benefits and eligibility is more important than ever. There are a variety of new health insurance
products on the market including limited benefit plans.
Currently BCBSLA does not offer limited benefit plans; however, you may see patients with limited benefits who
are covered by another Blue Plan.
Identifying Members: Out-of-state Blue members, who have limited benefits coverage, carry ID cards that have:
• either of two product names - InReach or MyBasic,
• a tagline in a green stripe at the bottom of the ID card; and,
• a black cross and/or shield to help differentiate it from other identification cards.
Verifying Eligibility: In addition to obtaining a copy of the patient’s ID card (regardless of the benefit product type), we
recommend that you verify patients’ benefits and eligibility. You may do so electronically through iLinkBLUE or you may
call 1.800.676.BLUE (2583) for out-of-area members. By verifying eligibility, you will receive the patient’s accumulated
benefits to help you understand the remaining benefits left for the member.
When benefits are exhausted: Any services beyond the covered amounts or the number of treatments may be
member’s liability. We recommend that you inform the patient of any potential liability they may have as soon as possible.
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Blue Cross and Blue Shield of Louisiana
Coverage and Eligibility Verification
Provider Financial Responsibility
Network providers are responsible for obtaining all required authorizations of applicable services for BlueCard Members.
Failure to obtain authorization may result in no payment or limitation of payments. Any unpaid charges or penalities that
result from failure to comply with authorization procedures will be absorbed by the provider, are not billable to the member.
Verifying Eligibility
For BCBSLA members, use iLinkBLUE (www.bcbsla.com/ilinkblue/) to verify eligibility and benefits or you may contact
Provider Services at 1.800.922.8866 for benefits.
For other Blue Plans’ members, choose one of the following methods to verify eligibility:
• Electronic—Submit a HIPAA 270 transaction (eligibility) to BCBSLA through iLinkBLUE under
BlueCard-Out of Area > Coverage Information Request.
•
Phone—Call BlueCard Eligibility at 1.800.676.BLUE (2583) to verify the patient’s eligibility and coverage. You can
receive real-time responses to your eligibility requests for out-of-area members between 6:00 a.m. and Midnight,
Central Time, Monday through Saturday.
• English and Spanish speaking phone operators are available to assist you.
• Keep in mind that Blue Plans are located throughout the country and may operate on a different time schedule than
BCBSLA. You may be transferred to a voice response system linked to customer enrollment and benefits.
• The BlueCard Eligibility line is for eligibility, benefit and pre-certification/referral authorization inquiries only. It
should not be used for claim status. See the Claim Filing section for claim filing information.
Utilization Review
When the length of an inpatient hospital stay extends past the previously approved length of stay, any additional days
must be approved. Failure to obtain approval for the additional days may result in claims processing delays and potential
payment denials.
You may also contact the member’s Blue Plan on their behalf. Here's how:
•
For BCBSLA members, contact Provider Services at 1.800.922.8866 for benefits.
•
For other Blue Plans members:
• Call BlueCard Eligibility 1.800.676.BLUE (2583)—ask to be transferred to the utilization review area.
• Submit an electronic HIPAA 278 transaction (referral/authorization) to BCBSLA.
• The member’s Blue Plan may contact you directly regarding clinical information and medical records prior to
treatment or for concurrent review or disease management for a specific member.
Answering Questions
Who do I contact with claims questions?
•
For claims inquiries, call Provider Services at 1.800.922.8866.
Time
Saver
How do I handle calls from members with claims questions?
If members contact you, tell them to contact their Blue Plan. Refer them to their ID card for a
customer service number. A member’s Plan should not contact you directly, unless you filed a
paper claim directly with that Plan. If the member’s Plan contacts you to send another copy of the
member’s claim, refer the Plan to BCBSLA.
Where can I find more information?
•Visit www.bcbsla.com. Click on Provider, then Out-of-State/BlueCard - OR • Log in to iLinkBLUE to view claim status and submit claims inquiries.
• Call Provider Services at 1.800.922.8866.
• Contact your BCBSLA Provider Relations representative—see our interactive map under I'm a
Provider, Provider Tools on www.bcbsla.com.
Blue Cross and Blue Shield of Louisiana
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Submitting Claims for BlueCard® members
You should always submit BlueCard claims directly to BCBSLA. The only exceptions are:
• If you are contracted with the member’s Plan (e.g., in contiguous county/parish or over-lapping service area
situations), in which case you should file the claim directly to the member’s Plan.
• If you are a dentist, please follow the instructions listed later in this section.
• Ancillary claims. See the Ancillary Claims section of this manual.
Once BCBSLA receives the claim, we will electronically route the claim to the member’s Blue Plan. The member’s Plan
then applies member benefits and processes the claim and approves payment, routes the claim back to BCBSLA.
BCBSLA will then reimburse you.
Filing Claims with Your National Provider Identifier (NPI)
Your NPI is used for claims processing and internal reporting. Claim payments are reported to the Internal Revenue
Service (IRS) using your tax identification number (TIN). To appropriately indicate your NPI and TIN on UB-04 and
CMS-1500 claim forms, follow the corresponding instructions for each form included in this manual. Remember, claims
processing cannot be guaranteed if you have not notified BCBS of your NPI, by using one of the methods above, prior to
filing claims. See the first part of this section for more details on how to submit claims to Blue Cross.
For more information, including whom should apply for an NPI and how to obtain your NPI, visit our website or CMS’
site at www.cms.hhs.gov/NationalProvIdentStand. If you have any questions about the NPI relating to your BCBSLA
participation, please contact Network Operations at 1.800.716.2299.
Referring Physician NPIs
Referring physician NPIs are required on all applicable claims filed with BCBS and HMOLA. Place the NPI in the
indicated blocks of the referenced claim forms:
•
•
•
•
CMS-1500: Block 17a
UB-04: Block 78
837P: 2310A loop, using the NM1 segment ad the qualifier of DN in the NM101 element
837I: 2310D loop, segment NM1 with the qualifier of DN in the NM101 element
For more information on NPIs, visit www.bcbsla.com/providers >NPI.
Hardcopy Claims
BCBSLA, Claims Department
P. O. Box 98029, Baton Rouge, LA 70898-9029.
Electronic Claims
Please submit electronic claims through BCBS Approved Clearinghouse locations. For more information about
filing claims through approved BCBS Clearinghouse locations, please contact our EDI Clearinghouse Support unit at
225.291.4334 or email [email protected].
Electronic claims also may be submitted through iLinkBLUE. For more information about filing claims through
iLinkBLUE, please call 1.800.216.BLUE (2583) or email us at [email protected].
Medicare Primary Claims Processed Through the BlueCard Program
When services are rendered for a member from another Blue Plan and Medicare is primary, claims should be submitted
directly to Medicare for primary payment. Medicare providers receive Electronic Remittance Advices (ERAs) in place of
hardcopy Remittance Advices (RAs). Upon receiving your ERA, please verify if Medicare crossed your claim(s) over to
the appropriate Blue Plan. Claims that are not-crossed over by Medicare should be filed directly to BCBSLA with a copy of
the Medicare ERA. Do not submit Medicare-related claims to BCBSLA before receiving an ERA from Medicare.
Please Note: BCBSLA only accepts ERAs printed using Medicare Remit Easy Print.
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Blue Cross and Blue Shield of Louisiana
Medicare Crossover Duplicate Claims
Effective Oct. 13, 2013, when a Medicare claim has crossed over, providers are to wait 30 calendar
days from the Medicare remittance date before submitting a claim to Blue Cross and Blue Shield of
Louisiana. Claims you submit to the Medicare intermediary will be crossed over to Blue Cross only
after they have been processed by Medicare. This process may take approximately 14 business
days to occur. As a result, upon receipt of the remittance advice from Medicare, it may take up to
30 additional calendar days from the crossover for you to recieive payment or instructions from Blue
Cross.
Providers should continue to submit services that are covered by Medicare directly to Medicare. Even
if Medicare benefits may exhaust or have exhausted, please continue to submit claims to Medicare to
allow the crossover process to occur and for the member’s benefit policy to be applied.
Medicare primary plans, including those with Medicare exhaust services that have crossed over and
are received within 30 calendar days of the Medicare remittance date or with no Medicare remittance
date will be rejected.
In addition, the following Medicare-crossover servicing updates are in place for all Blue Plans to more
accurately price and process Medicare claims:
• Providers should directly submit excluded services to BBCBSLA with a GY modifier on each line
of the claim for the service that is excluded or not covered by Medicare. Blue Cross will apply
the contracted rate with the provider to accurately process the claim according to the member’s
benefit benefitbenefit.
• The GY modifier should be used with the specific, appropriate Healthcare Common Procedure
Coding System (HCPCS) code, if available. If there is not a specific HCPCS code to describe the
services, a “not otherwise classified code” (NOC) must be used with the GY modifier.
• When a member has benefits for services excluded or not covered by Medicare, the provider will
receive a notification from Medicare with instructions to submit claims for those services directly
to Blue Cross. Instructions will be included in either a paper or electronic remittance advice or in a
letter from the Blue Plan.
For more information on Medicare crossover duplicate claims and pricing, or if you have any questions
regarding these changes, please call our Provider Relations Department at 1.800.716.2299, option 4
or email [email protected].
Blue Cross and Blue Shield of Louisiana
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10
Overpayments
BCBSLA does not process refund requests and does not request or accept checks from providers for refunds on claims for out-ofstate members. All overpayment reconciliation will be reflected on electronic remittance advices and/or payment registers.
When an overpayment on a claim for an out-of-state member may have been made, providers are required to fill out and
submit an Overpayment Notification Form for review to ensure that an overpayment did occur. A printable version of the
Overpayment Notification Form is located at www.bcbsla.com/providers >Forms for Providers. Complete the form and fax it
to 225.297.2727 or mail to:
BCBSLA, Correspondence
ITS Host Refunds
P.O. Box 98029
Baton Rouge, LA 70898-9029
Providers may also notify us of an overpayment via the action
request (AR) system available through iLinkBLUE for quick and
easy processing.
If it is found that an overpayment did occur, you will not receive further notification from us and your payment register will
reflect the change. If an overpayment did not occur, you will receive notification explaining that no change is necessary.
If an unsolicited refund is received from a provider or the member’s Home Plan, the check may be returned with a letter
requesting that an Overpayment Notification Form be submitted. If it is found that a provider has received an overpayment,
with or without the provider soliciting the refund, BCBS will send notification requesting the provider respond either agreeing or
appealing the overpayment within 30 days. If no response is received, the provider is notified that the claim may be adjusted if
necessary. Again, all transactions will be reflected on the provider’s payment registers or electronic remittance advices. If you
have questions on this process, please contact Provider Services at 1.800.922.8866.
Blue Cross and Blue Shield of Louisiana
June 2014
11
Ancillary Claims
Ancillary providers are independent clinical laboratories, durable/home medical equipment and supply providers, and
specialty pharmacies located within BCBSLA's service area. An ancillary provider located outside BCBSLA's service area
is considered a remote provider.
A remote provider is an independent clinical laboratory, durable/home medical equipment and supply or specialty
pharmacy provider located outside of BCBSLA’s service area that are contracted with BCBSLA under a license agreement
to act as a local provider solely for services rendered in our service area.
Ancillary Claims Filing Instructions
Ancillary claims for Independent clinical laboratory, durable/home medical equipment and supply, and specialty pharmacy
are filed to the local plan. The local plan is determined according to the below information:
• If a remote provider contract is in place with the local plan, the claim must be filed to the local plan, and it would
be considered a participating provider claim.
• If a remote provider contract is not in place with the local plan, the claim must be filed to the local plan, and it
would be considered a nonparticipating provider claim.
Independent Clinical
Laboratory (Lab)
The plan in whose service area the specimen is drawn. This is determined by the
state where the referring physician is located.
Durable/Home Medical
Equipment (DME/HME)
The plan in whose service area the equipment was shipped to or purchased at a retail
store.
Specialty Pharmacy
The plan in whose service area the ordering physician is located.
•
Specialty Pharmacy is characterized as non-routine, biological therapeutics
ordered by a healthcare professional as a covered medical benefit as defined by
the plan's Specialty Pharmacy formulary.
•
Specialty Pharmacy generally includes injectables and infusion therapies that
require complex care. Examples of major conditions these drugs treat include,
but are not limited to, cancer, HIV/AIDS and hemophilia.
Definition of Local Plan for Ancillary Services
Ancillary Claims Filing: Independent Clincal Laboratory (Lab) Claims
Lab claims must be filed to the Blue Plan where the specimen was drawn. Where the specimen was drawn will be
determined by which state the referring provider is located. The referring physician NPI number must be filed on all
ancillary claims. If the referring physician NPI is not listed, the claim will be returned.
•
CMS-1500 Health Insurance Claim Form:
-The NPI of the referring provider is identified in field 17B - NPI of Referring Provider or Other Source
•
837 Professional Electronic Submission:
-The NPI of the referring provider is populated in loop 2310A
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June 2014
Blue Cross and Blue Shield of Louisiana
Ancillary Claims Filing: Durable/Home Medical Equipment (DME/HME) Claims
DME/HME claims must be filed to the Blue Plan where the equipment was shipped to or purchased at a retail store.
•
CMS-1500 Health Insurance Claim Form:
-The patient address where the DME/HME was shipped to in field 5
-The NPI of the ordering provider is identified in field 17B - NPI of Referring Provider or Other Source
-The place of service (POS) in field 24B
-The service facility location in field 32 (for retail store information or location other than the patient address)
•
837 Professional Electronic Submission:
-The patient address is populated in loop 2010CA
-The NPI of the ordering provider is populated in loop 2420E
-The POS of the member is populated in loop 2300, CLM05-01
-The service facility location is populated in loop 2310C
Ancillary Claims Filing: Specialty Pharmacy Claims
Specialty pharmacy claims must be filed to the Blue Plan where the ordering physician is located.
•
CMS-1500 Health Insurance Claim Form:
-The NPI of the ordering provider is identified in field 17B - NPI of Referring Provider or Other Source
•
837 Professional Electronic Submission:
-The NPI of the ordering povider is populated in loop 2310A
Scenarios
• An independent laboratory receives and processes member’s blood specimen. Member’s blood was drawn in
Louisiana but processed in Texas by a contracted remote provider. The claim should be filed in Louisiana; the
service area where the specimen was drawn.
•
A durable/home medical equipment provider in Mississippi receives and processes a request for DME for a
member in Louisiana. The equipment is then shipped to Louisiana for the member for pick up and/or purchase. The
claim should be filed in Louisiana; the service area where the equipment is received/purchased.
•
A specialty pharmacy in Louisiana receives a prescription order for a non-routine, biological therapeutic drug for a
BCBSLA member who lives in Tennessee. The drug is ordered by a Tennessee provider. The drug is then shipped
to the BCBSLA member living in Tennessee. The claim should be filed in Tennessee; the service area where the
drug was ordered.
Blue Cross and Blue Shield of Louisiana
June 2014
13
Dental and Oral Surgery Claims
Dentists and oral surgeons should verify benefits for BlueCard Program members prior to performing services by calling
the number on the back of the member’s ID card. The following guidelines apply to BlueCard dental claims filing only.
ADA Claim Form
• Dental Providers and Oral Surgeons filing claims for dental services on an ADA claim form (hardcopy) should submit
the claim to the Blue Plan named on the member’s ID card; do not file with BCBSLA.
• Dental Providers and Oral Surgeons calling for claim status regarding dental services filed on an ADA claim form
should call the number provided on the BlueCard member’s ID card; do not call BCBSLA as we can not access this
information to assist you.
• ADA claim forms received by BCBSLA for dental services for BlueCard members will be sent back to the provider
advising the provider to file the claim to the Blue Plan named on the BlueCard member’s ID card.
• Dental claims submitted on an ADA claim form must be processed through the Blue Plan on the member’s ID card.
Providers should not expect payment from BCBSLA. The member or provider will get paid directly from the BlueCard
member’s Blue plan or intermediary adjudicating the claim.
• Providers should call the number on the BlueCard member’s ID card for inquiries regarding claim status for dental
services filed on an ADA claim form to the Blue Plan on the member’s ID card.
CMS-1500 and Electronic Claim Forms for Dental Services
• Electronic claims received by BCBSLA for dental services provided to BlueCard members will be returned to the provider
to re-file the claim to the Blue Plan named on the member’s ID card.
• It is recommended by BlueCard that Dental Providers and Oral Surgeons filing dental services that fall under the medical
care category do so on a CMS-1500 (professional) claim form or professional electronic claim form.
• Dental Services that fall under the medical care category and are filed on a on a CMS-1500 claim form or professional
electronic claim form will be processed by BCBSLA and sent to the Blue Plan named on the BlueCard member’s ID card
for adjudication under medical policy guidelines. This does not guarantee payment.
• Dental Services filed incorrectly or with missing information on a CMS-1500 claim form or professional electronic claim
form will be returned to the provider for a corrected claim.
• Dental claims submitted on a CMS-1500 claim form or professional electronic claim form may be processed through
BlueCard; therefore, providers should expect the remit or payment to come from BCBSLA, if the claim is processed to pay
the provider. If the claim is processed by the member’s home plan to pay the BlueCard member, the member will receive
payment from the member’s Blue Plan and not from BCBSLA.
• Providers should call BCBSLA for inquiries regarding claim status for dental services filed on a CMS-1500 claim form or
professional electronic claim form.
Claim Payment
BCBSLA's Guidelines for BlueCard Claims Payment
• If you have not received payment for a claim, do not resubmit the claim because it will be denied as a duplicate. This
also causes member confusion because of multiple Explanations of Benefits (EOBs).
• Check claim status by:
• Researching the claim through iLinkBLUE at www.bcbsla.com/ilinkblue/.
or
• Calling Provider Services at 1.800.922.8866.
Please note:
In some cases, a member’s Blue Plan may pend a claim because medical review or additional information is
necessary. When resolution of a pended claim requires additional information from you, BCBSLA may either ask you
for the information or give the member’s Plan permission to contact you directly.
Appeals
Appeals for all claims are handled through BCBSLA. We will coordinate the appeal process with the member's Blue Plan,
if needed.
For more information on the BCBSLA Appeals process, please see the Appeals section of your Professional Provider
Office Manual found on the Provider Page at www.bcbsla.com/providers >Education on Demand.
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Blue Cross and Blue Shield of Louisiana
Protocol for Provider Relations Involvement in Claims Resolutions
The following protocol should be used when contacting Provider Relations for claim resolution:
•
Submit an Action Request through iLinkBLUE (www.bcbsla.com/ilinkblue/). Allow 10-15 business days before
accessing iLinkBLUE for a claims resolution.
•
If no satisfactory resolution has been obtained, contact Provider Services at 1.800.922.8866. Provider Services will
issue a reference/task number. Allow 10-15 working days from the initial request before accessing iLinkBLUE for a
claims resolutions.
•
If claim has not been resolved satisfactorily, place a second call to Provider Services. Ask for a supervisor to escalate
claim for correct processing. An additional reference/task number will be issued. Allow 10-15 business days, before
accessing iLinkBLUE for a claims resolution.
•
If claim has not been resolved satisfactorily, contact your Provider Relations representative. Pertinent information will
need to be provided along with no less than two reference/task numbers and dates the Action Request were submitted.
•
The Provider Relations representative will escalate the issue to the manager of the appropriate unit for further
assistance. The unit manager will be responsible for the follow up and response to you.
To find the Provider Relations Representative assigned to your area, please view the online provider representative map
at www.bcbsla.com/providers >ProviderTools >Provider Representative Map or call 1.800.716.2299, option 4. To use the
map, simply roll your cursor over the parish you would like to review for information to see the names and phone numbers
of the Statewide, Provider Relations and Network Development representatives for your service area.
Blue Cross and Blue Shield of Louisiana
June 2014
15
Submitting BlueCard® Medical Records
All participating providers are required to return medical record request(s) within 30 calendar days of the
original requests. Failure to respond timely to these requests may result in limitation of payment or no
payment.
1. Always submit medical records directly to BCBSLA when you receive a Medical Record Request Form from BCBSLA.
2. Wait until you receive a request for medical records from BCBSLA before submitting medical records for any
denial or notification for: lack of information received, additional information needed or waiting on requested
information.
3. Promptly send medical records to BCBSLA after receiving a request for medical records.
4. Always include the Request for Medical Records Form that you received as the cover or first page of the records
BlueCard Medical Records should NOT be submitted:
• With a copy of the originally-filed claim as an attachment.
• Unless you received a request for medical records from BCBSLA.
• Without the Request for Medical Records Form.
• Via certified mail.
Medical Record Requests Available in iLinkBLUE:
Providers now have a new feature when logging into iLinkBLUE. After login, a message will show on the iLinkBLUE
message board when there are open BlueCard medical record requests for your patients.
You can access current and worked requests by clicking on the message link (as shown in example above) or from the
"Medical Record Requests" option of the iLinkBLUE menu bar. Currently, these BlueCard medical record requests are still
being sent to providers hardcopy in addition to being available on iLinkBLUE, and medical records must still be submitted
hardcopy to Blue Cross.
In 2014, two additional enhancements are coming:
1. Paper requests will cease. BlueCard medical record requests will only be issued via iLinkBLUE.
2. Paper submissions will cease. BlueCard medical record requests to be submitted via iLinkBLUE.
Upon receipt of medical records, please allow 30 days for BCBSLA and/or the member’s Blue Plan to complete the
review process. If no response is received after 30 days, please follow-up with BCBSLA by calling Provider Services
at 1.800.922.8866.
Blue Cross and Blue Shield of Louisiana
June 2014
16
Coordination of Benefits
Coordination of benefits (COB) refers to how the Blue System ensures that members receive full benefits from their health
benefit plans and prevents double payment for services when a member has coverage from two or more sources. Please
follow these guidelines when submitting claims to BCBSLA when COB is required:
• If BCBSLA or any other Blue Plan is the primary payer, submit the other carrier’s name and address with the claim to BCBSLA.
• If a non-Blue health plan is primary and BCBSLA or any other Blue Plan is secondary, submit the claim to BCBSLA only
after receiving payment from the primary payor, including the explanation of payment from the primary carrier.
Carefully review the payment information from all payers involved on the remittance advice(s) before balance billing the
patient for any potential liability.
Coordination of Benefits Questionnaire
To streamline claims processing and reduce the number of denials related to COB, a COB questionnaire is now available
to you on the Provider page at www.bcbsla.com/providers >Forms for Providers will help you and your patients avoid
potential claim issues. When you see any Blue members and you are aware that they might have other health insurance
coverage (i.e. Medicare), give a copy of the questionnaire to them during their visit. Ask them to complete the form and
send it to the Blue Plan through which they are covered as soon as possible after leaving your office. Members will find
the appropriate contact information on their ID card. Providers may submit the form to BCBSLA on behalf of the out-ofstate member and it will be communicated to the member's plan for updating.
If you do not include the COB information with the claim, the member’s Blue Plan will have to investigate the claim.
This investigation could delay your payment or result in a post-payment adjustment, which will increase your volume of
bookkeeping. For more information on BCBSLA’s COB process, see your Professional Provider Office Manual, available
at www.bcbsla.com/providers >Education on Demand.
Quick Tips:
Time
Saver
The BlueCard Program provides a valuable service that lets you file all claims for members from
other Blue Plans with your local Plan.
Here are some key points to remember:
• Make a copy of the front and back of the member’s ID card.
• Look for the three-character alpha prefix that precedes the member’s ID number on the ID card.
• Call BlueCard Eligibility at 1.800.676.BLUE (2583) to verify the patient’s membership and coverage or
submit an electronic HIPAA 270 transaction (eligibility) to BCBSLA.
• Submit the claim to BCBSLA. Always include the patient’s complete identification number, which includes
the three-character alpha prefix.
• For claims inquiries, call Provider Services at 1.800.922.8866.
Blue Cross and Blue Shield of Louisiana
June 2014
17
Medicare Advantage Members From Other Blue Plans
Government rule changes effective in 2009 enable health plans to enroll and cover some retiree group members in
Medicare Advantage (MA) HMO or PPO products, even in areas where a formal provider network is not available. BCBSLA
does not maintain a provider network for MA at this time; although, our providers may be asked to service a MA member
while they are in our service area. MA members who are enrolled in areas without a provider network (in this case,
Louisiana), are “non-network members,” and may receive care from any Original Medicare eligible provider, including all
Medicare participating providers.
BCBSLA network providers are currently encouraged, but not required, to render services to non-network members.
Should you decide to provide services to a MA member, you will be reimbursed for covered services at the “Medicare
Allowed Amount” based on where the services were rendered and under the member’s out-of-network benefits. Providers
should continue to verify eligibility and bill for services for any out-of-state Blue Plan member they agree to treat. Claims
are to be submitted directly to BCBSLA.
Medicare Advantage Member Servicing Confirmation Form
When providing services to a non-network MA member, providers will need to complete a Medicare Advantage Member
Servicing Confirmation Form. By completing this form, the provider agrees to provide services to a particular member for
the period of time indicated on the form at the Medicare Allowed Amount.
Providers may obtain a printable copy of the MA Member Servicing Confirmation Form from our website at www.bcbsla.com/
providers >BlueCard Out of State. Submit the form as instructed to [email protected] or fax to 225.297.2750.
If you have questions on servicing non-network or out-of-state MA members, contact Provider Services at 1.800.922.8866
or contact your Provider Relations Representative. To verify benefits, please refer to the number on the member’s ID card.
Frequently Asked Questions Regarding Treatment of Medicare Advantage Members
Q. What steps do I need to take when providing services to a non-network member?
A. 1) Verify eligibility by contacting BlueCard Eligibility® at 1.800.676.BLUE (2583). Be sure to ask if MA benefits apply.
2) Complete a MA Member Servicing Confirmation Form, which indicates that they will provide services to a particular
member. The confirmation form also includes the period of time that the services will be provided.
Q. Do MA members have a unique identification card?
A. MA members will have an identification card that will look the same as other members of the same employer group.
All MA cards will have the Medicare Advantage PPO/suitcase-type logo like the one shown here
Q.
How do I file a claim for a non-network member?
A. Claims are to be submitted directly to BCBSLA. Do not bill Medicare directly for any services rendered to a Medicare
Advantage member.
Q. How will I be paid for services rendered to a non-network member?
A. Non-network members’ claims will be adjudicated according to the benefits that their health plan provides. The claims will be
paid according to CMS guidelines. At a minimum, eligible claims will be reimbursed at the Medicare Allowed Amount based on
where the services were rendered and under the member’s out-of-network benefits.
Q. What is the Medicare Allowed Amount?
A. The Medicare Allowed Amount is the fee schedule reimbursement that Medicare would pay to a provider who accepts
assignment of benefits for services rendered to a member.
Q. Who do I contact if I have additional questions regarding on-network members?
A. If you have questions on servicing MA members, contact Provider Services at 1.800.922.8866.
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Blue Cross and Blue Shield of Louisiana
Medicare Advantage Private Fee-for-Service
Across the country Medicare Advantage plans have introduced Private Fee-for-Service options (PFFS). With PFFS,
insurers can offer employer groups the same MA plan coverage nationally, without building a provider network.
• PFFS is a Medicare Advantage plan offered by a health plan that provides coverage for all Medicare Part A and B
benefits at a minimum. It may require co-payments from members and pays providers on a fee-for-service basis.
• PFFS is a non-network plan that does not restrict member choice among providers as long as those providers agree
to accept the health plan’s terms and conditions of payment and are lawfully authorized to provide services under
original Medicare.
Who Can Provide Services to MA PFFS Members?
MA PFFS Blue Plans use the Centers for Medicare & Medicaid Services’ (CMS) Medicare Advantage Deemed Provider
concept, rather than direct contracts, to arrange for services for its MA PFFS members. Most Plans use the following
criteria to consider a provider “Deemed” for rendering services to a MA PFFS member:
• Provider is aware in advance that the person receiving the services is enrolled in a MA PFFS benefit plan and,
• Provider has reasonable access to information about the PFFS Plan’s terms and conditions of payment and,
• Provider is lawfully authorized to provide services under original Medicare.
General Rule: If a provider is aware that a member is a MA PFFS member, but chooses not to accept
the MA PFFS Plan’s terms and conditions of payment, they should not provide services to the MA PFFS
member, except in urgent or emergency care situations.
Recognizing Medicare Advantage PFFS Members
“Medicare Advantage” and “PFFS” will be indicated on the member’s ID card by including the logo shown here. Members
will not have a standard Medicare card; instead it will be a BCBS and/or Blue Shield ID card.
Providers should always ask for the member's ID card.
MA PFFS Benefits and Authorizations
To verify benefits or obtain authorizations, providers may call the number on the member’s ID card, submit an electronic
eligibility request through iLinkBLUE or call BlueCard Eligibility® at 1.800.676.BLUE (2583). Be prepared to provide the
member’s alpha prefix located on the ID card.
Submitting MA PFFS Claims
When a provider treats a MA PFFS member for covered services, claims are submitted to the local Blue Plan and that
Blue Plan then processes the claims through the BlueCard system. For instance, Louisiana providers should submit MA
PFFS claims directly to BCBS and Blue Shield of Louisiana via their current billing practices. Do not bill Medicare directly
for any services rendered to a MA PFFS member.
What reimbursement rates apply for MA PFFS patients?
Providers will be reimbursed the equivalent of the current Medicare payment amount for all covered services (i.e. the amount
you would collect if the member was enrolled in traditional Medicare.) The provider should refer to the member ID card
for instructions on how to access terms and conditions. Louisiana providers will receive their reimbursement directly from
BCBSLA the same as other BlueCard members.
Collecting member cost sharing amounts at the time of service
Providers may collect any applicable cost sharing amount (i.e. copayment, deductible) from MA PFFS members at the
time of service. Balance billing may be permitted under some PFFS plans, so refer to the member ID card for instructions
on how to access terms and conditions.
Disagreements on reimbursement amount received
If a provider believes that the payment amount they received for a service (including the member cost sharing collected)
is less than they would have received under original Medicare for the service, the provider should contact their local Blue
Plan to verify claim payment. Louisiana providers with questions on serving MA PFFS members may contact Provider
Services at 1.800.922.8866.
Blue Cross and Blue Shield of Louisiana
June 2014
19
BlueCard Frequently Asked Questions
Q.
How do I verify a member's benefits?
Member benefits and eligibility can be verified electronically through iLinkBLUE or you can
call BlueCard Eligibility® at 1.800.676.BLUE (2583). You will need the member's alpha prefix.
Complete instructions are available on iLinkBLUE.
A.
Q.A.
What about utilization review (authorization for services)?
Hospitals and other participating providers have agreed to obtain authorization for Blue members.
You should still remind patients from other Blue Plans of their responsibility for obtaining
authorization for their services from their Blue Plan.
When the length of an inpatient hospital stay extends past the previously approved length of
stay, any additional days must be approved. Failure to obtain approval for the additional days
may result in claims processing delays and potential payment denials.
You may contact the member's Plan on behalf of the member by:
• Calling BlueCard Eligibility at 1.800.676.BLUE (2583), and ask to be transferred to the
utilization review department.
• Submitting a HIPAA 278 transaction (referral/authorization) to BCBSLA.
Q.A.
Where do I send medical records?
When other Blue Plan members have a claim that requires medical records, you will receive a
request for medical records from BCBSLA. We will take the appropriate measures to forward
medical records to the member’s Blue Plan.
Q.A.
Who do I call about claims status, adjusting BlueCard claims and resolving other issues?
BCBSLA is your sole contact for claims status, adjustments and problem resolution. Providers
with access to our iLinkBLUE Provider Suite can check the status of claims online as well
as submit electronic requests for claims review. Providers may also call Provider Services at
1.800.922.8866 for all their service needs.
Q.A.
When and how will I be paid for BlueCard claims?
BlueCard claims payments are included in your weekly BCBSLA Provider Payment Register.
Providers with EFT receive their payments directly into their checking or savings account and
view their Weekly Provider Payment Registers in iLinkBLUE.
BCBS requires all providers to be a part of our electronic funds transfer (EFT) program. You must
have iLinkBLUE to be eligible for EFT. For more information on EFT, please call
BlueCard Eligibility at 1.800.676.BLUE (2583) or email [email protected].
Q.A.
What should I do when I haven’t received a payment for my BlueCard claim?
If you do not receive claims payment or a response regarding your claim, please do not resubmit
claims. Resubmitted claims are often denied as duplicates. First, check the claim's status on
iLinkBLUE. If claim information cannot be found online, call Provider Services at 1.800.922.8866
for status.
Participating providers agree not to bill members for any difference between billed charges and
the amount the provider has contractually agreed to accept as payment in full for those services.
In some cases, a member’s Blue Plan may require additional information to complete the
processing of a claim. If additional information is needed, BCBSLA may either ask you for the
information or give the member’s Plan permission to contact you directly.
Q.A.
How do I handle calls from members and others regarding claims status or payment?
If a member contacts you, tell the member to contact their Blue Plan. Refer them to the front or
back of their identification card for a customer service number.
The member’s Plan should not be contacting you directly. However, if the member’s Plan does
contact you to send them another copy of the member’s claim, refer them to BCBSLA.
Q.A.
How can I find out more information about the BlueCard Program?
For more information about the BlueCard Program, call BlueCard Eligibility at 1.800.676.BLUE
(2583), or visit the BlueCard website at http://www.bcbs.com/coverage/bluecard/pro/.
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June 2014
Blue Cross and Blue Shield of Louisiana
The BlueCard® Program
Provider Manual
www.bcbsla.com/providers
Network Administration Division
Provider Communications
1.800.716.2299 phone • 225.297.2750 fax
P.O. Box 98029 • Baton Rouge, LA 70898-9029
5525 Reitz Avenue • Baton Rouge, LA 70809-3802
®
23XX4272 R06/14
®
Blue Cross and Blue Shield of Louisiana incorporated as Louisiana Health Service & Indemnity Company