10 tips to improve your BlueCard^® experience

Over the past two years, we’ve been answering your questions about BlueCard in our “BlueCard^® Connection” feature in The Record. To help streamline your BlueCard experience, we’ve compiled key information from that feature into a series of 10 tips. We hope you find them helpful.

1. Check your patient’s eligibility, benefits and authorization requirements every visit by calling 1-800-676-2583. The member’s three-letter alpha prefix routes you to the member’s home plan. Taking the time to make the call at the time of service can save you time down the road and ensure prompt payment when the claim is filed.
2. Reference the BlueCard chapter available in every online provider manual frequently. The chapter includes detailed information on the BlueCard program, links to online tools and links to all of the BlueCard-related Record articles.  Using the BlueCard chapter of the manual as your point of reference may avoid a call to Provider Inquiry or help you prepare for the call when you need assistance.
3. Complete the medical record contact information available in the Provider Enrollment section of web-DENIS. Providing us with your billing office fax number allows us to fax any medical record requests we receive from out-of-area Blue plans directly to your office. Use the Medical Record Request form you receive as the cover sheet to return the medical records to Blue Cross Blue Shield of Michigan. The form will request the information needed to determine benefits on your claim. Note: Return only what’s requested. Sending information not requested can delay or deny the claim. If the information the plan is requesting isn’t available, return the Medical Record Request form, indicating the information isn’t available, and notify the member.
4. Report a valid, accurate and timely claim. Our standard reporting requirements apply to BlueCard claims.
5. View an out-of-area Blue plan’s medical policy to determine the plan’s medical criteria for a specific service. Links to the Medical Policy & Pre-Cert/Pre-Auth Router are available on web-DENIS — in the BlueCard chapter of every online provider manual — and on bcbsm.com.
6. Consider requesting a prior approval from the member’s home plan for ongoing treatment plans, such as IV therapy; physical, occupational or speech therapy; radiation oncology or chemotherapy. Check out the plan’s medical policy online and be prepared to provide the plan with the dates of service and expected treatment plan when calling for the prior approval. If approved, claims for these services will process without being denied for lack of medical records.
7. If you a receive a claim denial and the reason for the denial isn’t clear to you — or if you’ve resubmitted a claim and you receive the same denial — contact Provider Inquiry for assistance before rebilling the claim.
8. Contact Provider Inquiry to initiate a claim reconsideration if your BlueCard claim has denied for any reason other than that the member’s benefit doesn’t cover the service reported. Our Provider Inquiry representatives will review the claim with you and work with the plan, if necessary, on your behalf. Claims that deny because the service isn’t a covered benefit of the member’s contract should be addressed by the member and their plan.
9. View the web-DENIS broadcast messages at least weekly. Messages marked with a yellow “new” flag are those that were added within the last week. System issues or updates affecting BlueCard claims will be posted via web-DENIS broadcast messages.
10. Contact your provider consultant if you think updates to the BlueCard chapter of the online provider manuals are needed or if you’d like to request a Record article on a particular topic.

Blue Cross continues to work to improve your BlueCard experience through claims processing initiatives and efforts to educate our claims processing staff and Provider Inquiry representatives about BlueCard. We want to ensure that your claims are processed in a timely manner and that the information you receive about BlueCard is accurate. As always, if you have any questions or concerns about BlueCard, contact your provider consultant.