BlueCard for Professionals: Glossary of BlueCard Program Terms

Alpha Prefix - Three characters preceding the subscriber identification number on Blue Cross Blue Shield ID cards required for routing claims. It identifies the member's Blue Cross Blue Shield Plan or national account.

BCBS.com - Blue Cross and Blue Shield Association's Web site, which contains useful information for providers.

BlueCard Access® - A toll-free 800 number, 1-800-810-BLUE, you and members can use to locate providers in another Blue Cross or Blue Shield Plan's area. This number is useful when you need to refer the patient to a physician or healthcare facility in another location.

BlueCard Eligibility® - A toll-free 800 number, 1-800-676-BLUE, for providers to verify membership and coverage information on patients from other Blue Cross Blue Shield Plans. Calling BlueCard Eligibility will facilitate quicker payments.

BlueCard® PPO - A national program that offers members traveling or living outside of their Blue Cross Blue Shield Plan's area the PPO level of benefits when they obtain services from a physician or hospital designated as a PPO provider.

BlueCard® PPO Member - Carries an ID card with this identifier on it. Only members with this identifier can access the benefits of BlueCard PPO.

BlueCard® PPO Network - The network comprising those physicians, hospitals and other healthcare providers PPO members may elect to use to obtain the highest level of PPO benefits.

BlueCard® PPO Provider - A doctor, hospital or other healthcare entity enrolled in a network of designated PPO providers.

BlueCard® Program - A national program that enables members obtaining healthcare services while traveling or living in another Blue Cross Blue Shield (BCBS) Plan's area to receive all the same benefits of their contracting BCBS Plan and access to BlueCard providers and savings. The program links participating healthcare providers and the independent BCBS Plans across the country through a single electronic network for claims processing and reimbursement. The BlueCard Program allows you to submit claims for members from other BCBS Plans, including international BCBS Plans, directly to your local BCBS Plan.

BlueCard Worldwide® - A program that allows Blue Cross and Blue Shield members traveling or living abroad to receive inpatient and outpatient institutional and professional services from participating health care providers worldwide. The program also allows members of foreign Blue Cross and Blue Shield Plans to access U.S. BCBS provider networks.

Coinsurance - A provision in a member's coverage that limits the amount of coverage by the plan to a certain percentage, commonly 80 percent. Any additional costs are paid by the member out of pocket.

Coordination of Benefits (COB) - Ensures that people receive full benefits and prevents double payment for services when a member has coverage from two or more sources. The language gives the order for what insurance organization has primary responsibility for payment and what insurance organization has secondary responsibility for payment.

Copayment - A specified charge that a member must pay out-of-pocket for a specified service at the time the service is rendered.

Deductible - A flat amount the member must pay before the insurer will make any benefit payments.

Direct Care Provider - An individual or organization that offers care directly to the member. The direct care provider is in the same physical location as the member and offers care to patients from within the local Plan's service area. Some examples are: (1) a provider who physically examines the patient, (2) a lab that performs the blood draw from a patient, or (3) a technician who fits a prosthetic limb to the patient. The direct care provider should file claims to the local Blue Plan. BlueCard applies if the provider of service is outside the member's Plan's service area and does not contract with the member's Blue Plan.

Hold Harmless - An agreement with a provider not to bill the subscriber for any difference between billed charges for covered services (excluding coinsurance) and the amount the provider has contractually agreed with a BCBS Plan as full payment for those services.

Indirect Care, Support and Remote Provider (National Provider) - An individual or organization that offers care to patients from outside the local Plan's service area. Services may be provided from a single site or from multiple locations. The provider of service is the one who files a claim for a service supplied to the member. BlueCard applies if the provider of service is outside the member's Blue Plan's service area and does not contract with the member's Plan. The member's location at the time of service is irrelevant. Often the patient and the indirect care provider are in different physical locations.

National Account - Employer group that has offices or branches in more than one location, but offers uniform coverage of benefits to all of its employees.

Other Party Liability (OPL) - A cost containment program that recovers money where primary responsibility does not exist because of another group health plan or contractual exclusions. Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance.

Plan - Refers to any Blue Cross and/or Blue Shield Plan