BlueCard^® connection: Why are claims for my patient rejecting as ‘membership not found’?

There are times when a patient’s contract number changes during an enrollment year. When this happens, a new identification card is issued to the patient. If you’re billing the patient’s claim based on information in your internal system from a previous visit, this could happen. Oftentimes, the patient isn’t aware of the change.

To ensure that your BlueCard claim is processed with the correct patient information:

• Ask the patient to present his or her insurance card.
• Verify the patient’s benefits and eligibility.
• Update your internal system to reflect your patient’s most recent contract information.

If you disagree with how one of your claims was processed, you may contact Provider Inquiry for assistance. A representative will work with you to validate the correct patient information by contacting the appropriate out-of-state plan on your behalf.

For more information on the BlueCard program, including links and articles on online tools, see the BlueCard chapter of the online provider manuals.

If you’re experiencing issues with the information provided in the BlueCard chapter of the online manual — or if you’d like more information on a particular topic — contact your provider consultant.

Want to suggest a topic to be covered in this series? Send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.