| 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 physician or health care 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 www.bcbs.com/healthtravel/finder.html |
Use this Web site when you need to refer a patient to a physician
or health care 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 physician or hospital 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 Plan members traveling or living
abroad to access covered inpatient hospital care, outpatient
hospital care and professional services from participating health
care providers worldwide. The program also allows members of
international Blue Plans to access domestic (US) Blue Plan providers. |
| 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. |
| www.bcbs.com |
The Blue Cross and Blue Shield Association’s Web site,
which contains useful information for members and providers. |
| www.or.regence.com/provider |
Regence BCBSO's Provider Information Site includes
resources for providers, such as the BlueCard Provider Manual. |
