Do you know about our BlueCard processes?

At Blue Cross Blue Shield of Michigan, we want to ensure that health care providers have the information they need about BlueCard^®. This national program enables members of one Blue plan to obtain health care services while traveling or living in another Blue plan's service area.

About BlueCard

The program links participating health care providers with independent Blue plans across the United States and in more than 200 countries and territories worldwide through a single electronic network for claims processing and reimbursement. The BlueCard program lets you conveniently submit claims for members from other Blue plans, including international Blue plans, directly to Blue Cross Blue Shield of Michigan. Blue Cross is your single point of contact for all your claims-related questions.

Verifying coverage and eligibility

When a member from an out-of-state Blue plan (the home plan) requests care and presents a current Blue plan's identification card, before providing services, you (as the service provider for the host plan), should:

• Make copies of the front and back of the subscriber's ID card
• Verify membership and eligibility with the member’s home plan by one of the following methods:
• Calling the BlueCard Eligibility Call Center
• Accessing eligibility and benefits on Availity Essentials™, our provider portal

Members with coverage from a Blue plan may also present a debit card, which may be Blue-branded, to cover cost-sharing payments.

BlueCard Eligibility Call Center

Call the BlueCard Eligibility Call Center at 1-800-676-2583. State the three-character alpha-numeric prefix on the patient's ID card, and you’ll be connected with the patient's home plan to verify eligibility and benefits for health care coverage.

Prior authorization

You have the following options for determining prior authorization requirements:  

• Call the BlueCard Eligibility Call Center and choose the appropriate prior authorization prompt
• Use the Authorizations & Referrals page on Availity^®, our provider portal. For additional information, see the document Determining prior authorization requirements for members.

Timely filing

All original facility claims must be reported to Blue Cross within 12 months from the date of service, and all original professional claims must be reported to Blue Cross within 180 days of the date of service. All claim adjustment requests for both professional and facility claims must be billed to Blue Cross within 24 months of the date of service.

For more details, including information on how to submit claims for various services, see the “BlueCard Program” chapter of the Blue Cross Commercial Provider Manual.

Availity^® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services.