BlueCard^® program: Learn the basics

We want to improve your experience with the BlueCard program. So this month we’re launching a series of articles that will provide you with important information about the program, including a look at the online tools available to help you handle claims for members enrolled outside of Michigan. Our first article gives you an overview of BlueCard and how it works.

What is BlueCard?
BlueCard is a national program that allows members of a Blue plan to receive health care services while traveling or living in another Blue plan's service area. The program links participating health care providers with independent Blue Cross and Blue Shield plans across the U.S. and in more than 200 countries and territories worldwide.

The BlueCard program lets you submit claims for members from other Blue plans, including international ones, directly to Blue Cross Blue Shield of Michigan. Your claim is routed to the appropriate plan based on the member’s three-letter alpha prefix, which is visible on their Blue Cross ID card.

How does BlueCard work?
To make sure that claims processing is consistent among plans, the Blue Cross and Blue Shield Association^® developed “host” and “home” definitions to distinguish plan types and a list of responsibilities for each one.

For services received in Michigan, our BCBSM plan would be considered the host plan. We would be responsible for:

• Servicing Michigan providers
• Receiving and pricing their claims
• Routing claims with the pricing data to the member’s home plan
• Paying providers

The home plan is the plan where a member is enrolled. The home plan is responsible for:

• Servicing the member
• Determining eligibility
• Confirming member benefits per their contract
• Determining authorization requirements for provider services
• Determining medical and benefit policy as it applies to the services reported on claims 
• Determining the coordination of benefit policy when a claim is reported for secondary or tertiary benefits. 

You can find more information about the BlueCard program in our provider manuals located on web-DENIS. To find the manuals, log in to web-DENIS and click on BCBSM Provider Publications and Resources.

Do you have article ideas for our BlueCard series?
We want to hear from you if there’s specific information about the BlueCard program that you’d like to see featured in The Record. If you have any suggestions or any questions about the program, contact your provider consultant or send an email to ProvComm@bcbsm.com. Put “BlueCard series” in the subject line.

Be sure to check out next month’s issue of The Record to learn more about BlueCard.