The BlueCard claims process
- Member of another Blue Plan receives services from you.
- You submit the claim to Regence BCBSO.
- Regence BCBSO prices the claim based on your contracted rate,
verifies your network participation, and sends the claim electronically
to the member's Blue Plan.
- The member's Blue Plan:
4a. Verifies eligibility, adjudicates the claim according to the
member's benefits, and sends this information to Regence BCBSO,
and
4b. Issues an Explanation of Benefits (EOB) to the member.
- Regence BCBSO sends a payment voucher to you.
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Submitting claims
Submit BlueCard claims electronically with your other Regence BCBSO
claims or mail paper claims to:
Regence BlueCross BlueShield of Oregon
P.O. Box 30805
Salt Lake City, UT 84130-0805
- Be sure to include the member's complete ID number when you
submit the claim (incorrect or missing alpha prefixes or ID numbers
delay claims processing).
- Do not send duplicate claims.
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Exceptions to BlueCard claims
submissions
Submit claims directly to the member's Blue Plan instead of Regence
BCBSO in the following situations:
- You contract with the member's Blue Plan.
- The ID card does not include an alpha prefix.
- The claims are excluded from the BlueCard Program (e.g., dental,
prescription medications and FEP claims).
When in doubt, please submit the claim to us electronically or
send the claim to us at the address stated above.
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International claims
The submission process for international claims is the same as for
domestic Blue Plan members.
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Coordination of Benefits (COB) claims
Coordination of Benefits (COB) refers to how we ensure members receive
benefits while preventing over payment for services when a member
has coverage from two or more payers. The member's contract language
explains which payer has primary responsibility for payment. Please
follow the procedures below for submitting COB claims.
Member has coverage with two out-of-area Blue Plans
- Send the claim to Regence BCBSO with the primary ID first.
- After you receive the Explanation of Benefits (EOB), send
the information with a new claim to Regence BCBSO for secondary
payment. The initial claim will not automatically cross-over
in the BlueCard system.
Another carrier is the primary payer and a Blue Plan
is secondary
- Bill the other carrier first.
- Send the EOB from the other carrier with the claim to Regence
BCBSO for secondary payment.
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Medicare-related claims
If you accept Medicare assignment and render services to members
from other Blue Plans, please note the following.
Blue Plan is primary and Medicare is secondary
When a Blue Plan is the primary payer (e.g. Medicare Advantage
- formerly Medicare+Choice) and Medicare is secondary, submit
claims to Regence BCBSO. Do not bill Medicare directly for any
services rendered to a Medicare Advantage member.
Medicare is primary and a Blue Plan is secondary
When Medicare is the primary payer for an out-of-area Blue Plan
member (e.g., Medigap plans), follow these procedures:
- Submit claims to your local Medicare contractor first. Do
not file with Medicare and the supplemental insurer simultaneously.
Be sure to include the complete Health Insurance Claim Number
(HICN), the patient's complete ID number, and Blue Plan's name
as it appears on the card.
- After you receive an Explanation of Medical Benefits (EOMB)
or Medicare Remittance Notice (MRN), determine if the claim
was automatically crossed-over to the supplemental insurer:
- Crossed over: If the indicator on the EOMB
or MRN shows that the claim was crossed-over, Medicare has forwarded
the claim on your behalf to the appropriate Blue Plan and the
claim is in process. You do not need to file for the Medicare
supplemental benefits. The Medicare supplemental insurer will
automatically pay you, if you accepted Medicare assignment.
Otherwise, the member will be paid and you will need to bill
the member.
- Not crossed over: If the EOMB or MRN does
not indicate the claim was crossed-over, file the claim as you
do today to Regence BCBSO. Regence BCBSO or the member's Blue
Plan will pay you the Medicare supplemental benefits. If you
did not accept Medicare assignment, the member will be paid
and you will need to bill the member.
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Checking claims status
You can check the status of a claim by phone or by submitting an
electronic inquiry.
Phone: If you have BlueCard claims-related questions,
call Regence BCBSO's BlueCard Provider Customer Service in Portland
at 1 (800) 448-0525 or
(503) 225-5393.
Electronic inquiry: Submit a HIPAA 276 transaction
(claims status request) to Regence BCBSO. The majority of BlueCard
electronic inquiries are answered within 48-72 hours (Monday through
Friday during regular office hours).
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Receiving payment
Once Regence BCBSO receives a claim, we will price the claim based
on your contract with us and electronically route the claim to the
member's Blue Plan. The member's Blue Plan adjudicates the claim
and approves payment based on the member's benefits. Regence BCBSO
will reimburse you accordingly and provide information on your payment
voucher.
- If the ID card shows a suitcase logo, reimbursement will be
based on the Oregon contracted rate.
- If the ID card shows no suitcase logo, reimbursement will be
based on the Home Plan contracted rate, and charges over the maximum
allowable are patient responsibility.
- Medicare Private Fee for Service (PFFS) paid at the Home plan contracted rate or Medicare rate, depending on the member contract. Provider may only collect the applicable copayment or coinsurance under the PFFS plan from the member.
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