BlueCard^® Provider Manual

Verifying eligibility and coverage

Verifying eligibility
Once you've identified the alpha prefix, you may verify membership and coverage by phone or by submitting electronic inquires.

Phone:

1. Call the telephone number on the back of the member's ID card.
2. If that information is not available, call BlueCard Eligibility line at 1 (800) 676-BLUE (2583) You will be prompted for the member's alpha prefix and connected to the appropriate Blue Plan.

• English and Spanish speaking representatives are available to assist you.
• Blue Plans are located throughout the country and may operate on a different time schedule than Regence BCBSO. You may be transferred to an interactive voice response system linked to customer enrollment and benefits or you may need to call back.
• The BlueCard Eligibility line is for eligibility, benefit and pre-certification/referral authorization inquiries only. It should not be used for claim status. (See the Filing Claims section for more information.)

Electronic inquiry: Submit a HIPAA 270 transaction (eligibility) to Regence BCBSO. The majority of BlueCard electronic inquiries are answered within 48-72 hours (Monday through Friday during regular business hours).

Pre-authorizations

Obtaining pre-authorizations
You should remind patients that they are responsible for obtaining pre-certification/pre-authorization for their services from their Blue Plan. Please note: Other Blue Plans' pre-authorization requirements may differ from Regence BCBSO's.

You may also choose to contact the member's Blue Plan on behalf of the member by phone or by submitting electronic inquiries.

Phone: Call the telephone number on the back of the member's ID card or BlueCard Eligibility at 1 (800) 676-BLUE (2583). You will be prompted for the member's alpha prefix and connected to the appropriate Blue Plan. Ask to be transferred to the utilization review area.

Electronic inquiry: Submit a HIPAA 278 transaction (referral/authorization) to Regence BCBSO. The majority of BlueCard electronic inquiries are answered within 48-72 hours (Monday through Friday during regular office hours).

Please note: When the length of an inpatient hospital stay extends past the previously approved length of stay, any additional days must be approved. Failure to obtain approval for the additional days may result in claims processing delays and potential payment denials.