BlueCard^® Provider Manual

Identifying members

Member identification (ID) cards
When members of Blue Plans arrive at your office or facility, be sure to ask them for their current Blue Plan membership ID card. To ensure accurate claims processing, it is critical to capture all ID card data. If the information is not captured correctly, you may experience a delay with claims processing.

Important facts concerning member IDs:

• The main identifiers of BlueCard eligible members are an alpha prefix and a suitcase logo.
• A correct member ID number includes the alpha prefix and all subsequent characters, up to 17 positions total. Others may be fewer than 17 positions.
• The alpha prefix on a member's ID card is three characters. (See the Alpha Prefix section below for more information.)
• Some member ID numbers may include alpha characters in other positions following the alpha prefix.
• The alpha prefix is critical for the electronic routing of specific (Health Insurance Portability and Accountability Act) HIPAA transactions to the appropriate Blue Plan.

Do's and don'ts

• Ask for the member's ID card and submit the ID number, including alpha prefix, exactly as it appears.
• Make copies of the front and the back of the member's ID card and share this information with your billing staff.
• Don't add/delete characters or numbers within the member ID.
• Don't change the sequence of the characters following the alpha prefix.
• Don't assume that the member's ID number is their social security number (SSN). (Use of SSNs on ID cards will be phased out by January 1, 2006.)

Alpha prefix
The alpha prefix on the member’s ID card is the key element used to identify and route claims. The alpha prefix on a member’s ID card is generally three characters. (You may see ID cards with four-character alpha prefixes, e.g., HMSA Blue Cross Blue Shield of Hawaii uses four-character alpha prefixes.) The alpha prefix identifies the Blue Plan or national account to which the member belongs. It is critical for confirming a patient’s membership and coverage.

There are two types of alpha prefixes: plan-specific and account specific.

1. Plan-specific alpha prefixes are assigned to every Blue Plan and start with X, Y, Z or Q. The first two positions indicate the Blue Plan to which the member belongs. The third position identifies the product in which the member is enrolled.
   • First character: X, Y, Z or Q
   • Second character: A-Z
   • Third character: A-Z
2. Account-specific alpha prefixes are assigned to centrally processed national accounts. National accounts are employer groups that have offices or branches in more than one area, but offer uniform benefits coverage to all of their employees. Typically, a national account alpha prefix will relate to the name of the group. All three positions are used to identify the national account.
   • First characters: letters other than X, Y, Z or Q.

Identification cards with no alpha prefix
Some identification cards may not have an alpha prefix. This indicates that the claims are handled outside the BlueCard Program.

Please look for instructions or a phone number on the back of the member's ID card.

Suitcase logo
In addition to the alpha prefix, member ID cards may also have:

• A blank suitcase logo
• A PPO in the suitcase logo for eligible Preferred Provider Organization (PPO) members, and
• No suitcase logo.

Blank suitcase logo
A blank suitcase logo on a member's ID card means that the patient has traditional, point of service (POS) or Health Maintenance Organization (HMO) benefits delivered through the BlueCard Program. (See the sample ID card below.)

• If members are enrolled in primary care physican (PCP) panels, the ID card will include an office visit co-payment, if applicable.

PPO in a suitcase logo
You'll immediately recognize the BlueCard PPO members by the special "PPO in a suitcase" logo on their ID card. BlueCard PPO members are members of Blue Plans with PPO benefits, delivered through the BlueCard Program.

BlueCard PPO members traveling or living outside of their Blue Plan's service area receive the PPO level of benefits when they obtain services from designated BlueCard PPO physicians, other health care professionals or facilities. To find out if you are a BlueCard PPO provider, visit www.bcbs.com.

It's important to remember that not all PPO members are BlueCard PPO members, only members whose ID cards carry this logo.

No suitcase logo
If the member's ID card has an alpha prefix but does not have a suitcase logo, send the claim to your local plan--Regence BCBSO.

Consumer directed health care (CDHC) and debit cards
Consumer directed health care (CDHC) is a broad umbrella term that refers to a movement in the health care industry to empower members, reduce employer costs and change consumer health care purchasing behavior.

Members who have CDHC plans often carry health care debit cards that allow them to pay for out-of-pocket costs using funds from their Health Reimbursement Arrangement (HRA), Health Savings Account (HSA) or Flexible Spending Account (FSA). Some cards are “stand-alone” debit cards used to cover out-of-pocket costs, while others serve as ID cards with the ID number.

Look for the familiar logos: The card will have the nationally recognized Blue Cross and/or Blue Shield logos, along with the logo from a major debit card such as MasterCard® or Visa®.

Sample stand-alone debit card

Sample stand-alone debit card
Sample combined debit card and member ID card

Swipe the card like an ordinary debit card: The cards may include a magnetic strip. With the health debit cards that include a magnetic strip, members can pay for copayments and other out-of-pocket expenses by swiping the card through any debit swipe terminal at the point of service. The funds will be automatically deducted from the member’s appropriate HRA, HSA or FSA account.

It saves time and money: Combining a health insurance ID card with a source of payment is an added convenience to members and physicians, other health care professionals and facilities. Members can use their cards to pay outstanding balances on billing statements. They can also use their cards via phone in order to process payments. In addition, members are more likely to carry their current ID cards, because of the payment capabilities.

If your office currently accepts credit card payments, there is no additional cost or equipment necessary. The cost to you is the same as the current cost you pay to swipe any other signature debit card.

Helpful tips: If the member presents a debit card (stand-alone or combined):

• Be sure to verify the copayment amounts before processing the payment.
• Do not use the card to process full payment up front.
• Call the toll-free debit card administrator’s number on the back of the card for debit card processing instructions or payment issues.

Identifying international members
Occasionally, you may see ID cards from international Blue Plan members.

• These ID cards will also contain alpha prefixes.
• Treat these members the same as domestic Blue Plan members.

Front and back of an ID card of a Blue Plan member from Uruguay.

Please note: The ID cards for Canadian Blue Cross members do not have an alpha prefix or a suitcase logo. Please follow the instructions on the back of the ID card to check eligibility and file claims.