| Alpha Prefix |
Three characters* preceding the identification
(ID) number on Blue Plan ID cards. The alpha prefix
identifies a member's Blue Plan or national account.
(*Some plans such as HMSA Blue Cross Blue Shield
of Hawaii use four alpha characters for their alpha
prefix). |
BlueCard Access®
1 (800) 810-BLUE (2583) |
Use this toll-free number when you need to
refer a patient to a a physician, other health
care professional or facility in another location.
You can also visit the BlueCard Doctor and Hospital
Finder online at www.bcbs.com/healthtravel/finder.html |
BlueCard Doctor and Hospital Finder Web
site
www.bcbs.com/healthtravel/finder.html
|
Use
this Web site when you need to refer a patient
to a a physician, other health care professional
or facility in another location.
You may also call BlueCard Access at
1 (800) 810-BLUE (2583).
|
BlueCard Eligibility®
1 (800) 676-BLUE (2583) |
Call this toll-free number to verify eligibility
and coverage information on patients from other
Blue Plans.
|
| BlueCard Traditional, Health Maintenance
Organization (HMO) or Point-of-Service (POS) |
A national program that offers members traveling
or living outside of their Blue Plan's area traditional
(participating), HMO, or POS level of benefits when
they obtain services from a primary care provider/group
and/or comply with referral and/or authorization
requirements for care. |
| BlueCard Preferred Provider Organization
(PPO) |
A national program that offers members traveling
or living outside of their Blue Plan's area the
PPO level of benefits when they obtain services
from a a physician, other health care professional
or facility designated as a BlueCard PPO provider.
To find out if you're a BlueCard PPO provider, visit
www.bcbs.com. |
BlueCard PPO Members 
|
BlueCard PPO members carry an ID card with
the PPO in a suitcase logo. Only members with
this identifier can access the benefits of BlueCard
PPO. |
| BlueCard Worldwide® |
A program that allows Blue Cross and/or Blue Shield
members traveling or living abroad to receive nearly
cashless access to covered inpatient hospital care,
as well as access to outpatient hospital care and
professional services from participating a physicians,
other health care professionals or facilities worldwide.
The program also allows members of international
Blue Cross and/or Blue Shield Plans to access domestic
(U.S.) Blue Plan physicians, other health care professionals
or facilities. |
| Blue Plan |
Refers to any Blue Cross and/or Blue Shield
Plan. |
| Coinsurance |
A means of sharing the cost of health care services
between a health plan and a member in which the
member pays a fixed percentage of the allowable.
For example, the member might be responsible for
20% of the allowable. The health plan would pay
the other 80% of the allowable. |
| Coordination of Benefits (COB) |
A system that prevents over payment for services
when a member has coverage from two or more sources.
The member's contract language gives the order for
which payer has primary responsibility for payment
and which entity has secondary responsibility for
payment. |
| Copayment |
The fixed dollar amount a member pays for
specified types of medical care. |
| Deductible |
An annual out-of-pocket amount the member must
pay before the health plan will make any benefit
payments. |
| FEP |
The Federal Employee Program. |
| Hold Harmless |
To write-off, adjust, or not charge a member
for balances other than deductible, copayment,
coinsurance and contract-excluded amounts. |
Medicare Advantage
(formerly Medicare+Choice)
|
A risk product offered by private insurance companies
to Medicare beneficiaries enrolled in Parts A and
B. These plans may provide more choices than original
Medicare and benefits to members, such as extra
days in the hospital. |
| Medicare Crossover |
A system that provides electronic transfer or
"crossover" of Medicare claim data from
the Medicare contractor to the supplemental insurer.
|
| Medicare Supplemental (Medigap) |
A health plan sold by private insurance companies
to fill the "gaps" in the original Medicare Plan.
These plans help beneficiaries pay for coinsurance,
copayments and deductibles. |
| National Account |
An employer group that has offices or branches
in more than one location but offers uniform coverage
benefits to all employees. |
| Other Party Liability (OPL) |
Other Party Liability (OPL) is a cost containment
program that recovers money where primary responsibility
does not exist because of another group health plan
or contractual exclusions. OPL includes coordination
of benefits, worker’s compensation, subrogation
and no-fault auto insurance. |
| www.bcbs.com |
The Blue Cross and Blue Shield Association's Web
site, which contains useful information for members
and physicians, other health care professionals
and facilities. |
| www.or.regence.com/provider |
Regence BCBSO's Provider Information Site
includes resources for physicians, other health
care professionals and facilities, such as the BlueCard
Provider Manual, online workshops and updates. |
