![]() Which claims are mailed to the Dallas address?Īll claims should be filed electronically when possible. Most other products (POS, HMO or Traditional) will reflect an empty suitcase logo on the ID card. Is there something on the (BlueCard) out-of-state ID card to determine if the member is an HMO, PPO, or Traditional member?įor PPO members, the letters “PPO” will appear inside the suitcase. Is the current remittance based on our BCBSTX contract? You may contact BCBSTX to establish if your claim was forwarded. Generally, BCBSTX will manually forward your claim to the appropriate BCBS plan. Why do I receive Provider Claim Summaries advising me to send my claim to the member’s BCBS plan?Īt times BCBSTX is unable to process the claim through the (BlueCard) out-of-state program, and it must be filed directly to the member’s BCBS plan. Yes, unless advised otherwise when obtaining eligibility and benefits. If your claim was filed to BCBSTX, most inquiries will be handled by the Texas Provider Customer Service Department. When we call BCBSTX for claim status and they are unable to assist, where do we call? For (BlueCard) out-of-state members you should call 1-800-676-BLUE (2583), voice the three-character prefix at which time you will be transferred to the member’s plan where they can disclose the member’s eligibility and benefits. How do I know what the benefits are for (BlueCard) out-of-state claims?Īs with any member, benefits should be obtained prior to providing services. BlueCard is a program of the BlueCross BlueShield Association. Why don’t (BlueCard) out-of-state claims go directly to the member’s plan?īy filing with your BCBSTX plan, this enables the member to obtain their maximum benefits while allowing the provider to receive their contracted rate. The member’s BCBS plan will notify BCBSTX on how to apply the member’s benefits to the claim. Who is responsible for benefit determinations? All non-PPO BlueCard member ID cards must include the designated blank suitcase logo. In order for them to obtain the highest level of benefits, they would need to seek services from an in-network Physician. If an ID card reflects a suitcase with PPO on the inside, it generally means the member is enrolled in a PPO plan. Why do some BCBS member’s ID cards reflect a suitcase and some do not? ![]() ![]() You would need to contact the patient or employer group for claim filing information. ![]() Where do I send an out-of-state claim when the ID card does not have a three-character prefix? Generally, Texas Providers send appeals to BCBSTX and will coordinate with the members plan. (BlueCard) out-of-state appeals should be filed to the same address that the claim was filed. Where do we send an appeal for a BlueCard claim? ![]() The three-character prefix is assigned to multiple BCBS plans and there is not a specific prefix to designate traditional plan members. Is there a certain three-character prefix to designate a traditional BlueCard member? Unfortunately, BCBSTX does not maintain membership information for out-of-state plans. In an emergency, if a member’s ID card is not available can we call BCBSTX for the three-character prefix? ![]()
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