bcbsaz quick guide to blue cross and blue shield id cards

MAY 2013 Quick Guide to Blue Cross and/or Blue Shield Member ID Cards 1May

AUGUST 2017

BCBSAZ Quick Guide to Blue Cross and Blue Shield ID Cards

AUGUST 2017 BCBSAZ Quick Guide to Blue Cross and Blue Shield Member ID Cards 2

Contents Introduction ......................................................................................................................................................... 3

Sample of a local BCBSAZ member ID card .................................................................................................... 3 Member ID Prefix ................................................................................................................................................. 4

Sample of a member ID card for a member from a Blue Plan other than BCBSAZ......................................... 4

Federal Employee Program (FEP) ID Cards ..................................................................................................... 5

Sample of an ID card for a member with an FEP Basic benefit plan ............................................................... 5

Sample of an ID card for a member with an FEP Standard benefit plan: ........................................................ 5

Corporate Health Services (CHS) ID Cards – Network-only arrangements .................................................. 6

Sample ID card for a CHS group member........................................................................................................ 6

International ID Cards ......................................................................................................................................... 7

ID cards from members with Blue Cross Blue Shield Global coverage ........................................................... 7

ID cards from members of International (out of U.S.) Blue Cross Blue Shield Licensees ............................... 8

Canadian Association of Blue Cross Plans ..................................................................................................... 9

Sample of a member ID card from a licensee of the Canadian Association of Blue Cross Plans ................... 9

Benefit Product “Suitcase” Logos .................................................................................................................. 10

Blank (Empty) Suitcase ....................................................................................................................... 10

PPO in a Suitcase ............................................................................................................................. 10

PPOB in a Suitcase ......................................................................................................................... 10

No Suitcase .................................................................................................................................................... 11

Medicaid Product ID Cards .............................................................................................................................. 12

Medicare Advantage Product ID Cards .......................................................................................................... 13

Sample of a BlueCard card for a member with an out-of-area Medicare Advantage benefit plan ................. 13

Local BCBSAZ Advantage Product ID Cards ................................................................................................. 14

Sample of a BCBSAZ Advantage ID card ...................................................................................................... 14

Consumer-Directed Healthcare and Healthcare Debit Cards ....................................................................... 15

Sample of a stand-alone healthcare debit card .............................................................................................. 15

Sample of a combined healthcare debit card and member ID card ............................................................... 15


Introduction This guide gives an overview of the various Blue Plan ID cards, the symbols on the cards, and how to use the information displayed on the ID cards.

When interacting with BlueCard® members, remember to ask for current member ID card information for each visit. This will help identify the type of benefit plan the member has, obtain eligibility and precertification contact information, and assist with claims processing.

For local BCBSAZ members, the AZBlue mobile app can be used to email the current digital ID card to a provider office. Members need to activate an online account on azblue.com in order to download the free app. We recommend getting the ID card information during the scheduling call to ensure you are an in-network provider for the member’s specific benefit plan.

Remember: ID cards are for identification purposes only; they do not guarantee eligibility or payment of a claim. Patient eligibility can be verified by:

• Using the online Eligibility and Benefits Inquiry tool on the secure provider portal at azblue.com/providers Or:

• Calling 1 (800) 676-BLUE (2583) Or:

• Calling the number on the back of the member ID card.

Sample of a BCBSAZ member ID card This sample is for a large employer group benefit plan, using the Statewide PPO Network:

For additional samples of BCBSAZ ID cards, please view or download the provider eLearning module on BCBSAZ Products, Networks and ID Cards. Log in to azblue.com and go to Education & Training to click on eLearning Modules, and then scroll down to find the topic.

http://www.azblue.com/Providers


Member ID Prefix The majority of Blue-branded ID cards display a 3-character prefix (often made up of 3 letters) in the first three positions of the member’s ID number. However, there are some exceptions to this; ID cards for the following products do not have the typical 3-letter prefix: • CHS group plans – There is no prefix on the member ID number, however, there is a unique group

number that is critical for routing claims. The group number typically begins with 3 letters, followed by 3 numbers.*

• Stand-alone vision and pharmacy products when delivered through an intermediary model (using a vendor)*

• Stand-alone dental products* • Federal Employee Program (FEP) plans – The member ID starts with the letter “R” followed by 8 numbers* • The BCBSAZ Dental prefix is 99D.

*Follow instructions on these ID cards on how to verify eligibility, submit claims and who to contact with questions.

The prefix is important for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. When filing the claim, always enter the member ID number exactly as it appears on the member’s card, inclusive of the prefix. Also include this complete identification on any documentation pertaining to services, to ensure accurate handling by the Blue Plan.

A correct member ID number includes the prefix and all subsequent characters, up to a total of 17 positions. Thus, it’s possible to see cards with ID numbers consisting of the prefix followed by between 6 and 14 numbers/letters. The following are examples of member IDs showing the prefix:

Alpha Prefix

ABC1234567

Alpha Prefix

ABC1234H567

Alpha Prefix

ABCD1234H567

Alpha Prefix

ABCD1234H56789012

Note: letters can be in other positions in addition to the first three characters.

Sample of a member ID card for a member from a Blue Plan other than BCBSAZ The red outline indicates the location of the member ID prefix:

Always use the exact prefix from the member’s current ID card. If there is no prefix on the card, never create one or use a prefix from another member’s ID card, even one from the same Blue Plan. It may cause delays in the handling of inquiries and claims. If the card presented has no prefix displayed, follow the instructions on the back of the ID card for inquiries and claim handling.

Prefix Prefix Prefix Prefix


Federal Employee Program (FEP) ID Cards FEP members’ ID cards do not display a three-character prefix. Rather, all FEP member identification numbers begin with the letter "R," as indicated on the sample ID cards below. For additional information regarding FEP and its ID cards, please refer to the FEP content in Sections 8, 9 and 16 of the BCBSAZ Provider Operating Guide.

Sample of an ID card for a member with an FEP Basic benefit plan

Sample of an ID card for a member with an FEP Standard benefit plan:


Corporate Health Services (CHS) ID Cards – Network-only arrangements Corporate Health Services (CHS) provides large, self-insured groups access to BCBSAZ provider networks and the groups assume all liability for claims payment. BCBSAZ prices the claims, but does not provide administrative or claims payment services. All ID cards for CHS group members display the statement:

Blue Cross Blue Shield of Arizona provides network access only and provides no administrative or claims payment services and does not assume any financial risk or obligation with respect to claims. No network access is available from Blue Cross Blue Shield Plans outside Arizona.

ID cards for CHS accounts are not Blue Plan ID cards and therefore do not include a prefix as part of the [member] ID number. CHS ID card formatting varies. Some cards may display a member’s name and ID number and some may not. It is important to obtain the member identification information at the time of service.

CHS cards display the BCBSAZ name/logo on the back of the card to indicate that the individual has access to the BCBSAZ provider network within Arizona. CHS groups do not have access to the extended BlueCard network outside of Arizona.

CHS Group Number CHS group member ID cards display an assigned BCBSAZ CHS group number, typically consisting of three letters followed by three numbers. The BCBSAZ CHS group number must be included with all claims submissions. Most CHS groups use a third party administrator (TPA) for claims processing, eligibility or benefits. The group number is required for routing the claim to the correct TPA for processing. Cards display the TPA name. For additional information regarding CHS groups, please refer to the CHS content in the BCBSAZ Provider Operating Guide, Sections 8, 9, 11, 16, 21 and 25.

Sample ID card for a CHS group member The sample ID card below is an illustration only as CHS group member ID cards vary by employer group and may include other names, logos and information.

The BCBSAZ-assigned group ID number must be on all claim submissions (format is 3 letters followed by 3 numbers). Please note: there is also a TPA-assigned group number on this card. Do not use this number on claims.


International ID Cards Occasionally, BCBSAZ providers may see ID cards from members with Blue Cross Blue Shield Global®

coverage or members with benefit plans from BCBS International Licensees. Please treat these members the same as domestic Blue Plan members.

• Check eligibility and benefits using the online eligibility and benefits tool at www.azblue.com/providers or call the U.S. Customer Service number on the back of the ID card.

• Do not collect any upfront payment from the member beyond applicable cost-share amounts such as deductible, coinsurance and co-payment.

• File claims to BCBSAZ. • Check claim status by using the online claim status tool at www.azblue.com/providers or use the

automated IVR phone system at (602) 864-4320 or 1 (800) 232-2345.

ID cards from members with Blue Cross Blue Shield Global coverage A full portfolio of international products is available under the Blue Cross Blue Shield Global brand. These products serve the needs of mobile individuals and employees when living, working, studying or traveling globally. The products can be supplemental or stand-alone, and have a wide range of coverage options. They include:

• Expatriate, Travel, and Student/Faculty benefit plans, sold inside the U.S. by GeoBlue1

• Expatriate and Globalist benefit plans, sold outside of the U.S. by Bupa Global2

Below are current examples of member ID cards for international products:

Blue Cross Blue Shield Global ID card

GeoBlue ID card (eventually, ID cards for this type of product will display the Blue Cross Blue Shield Global logo)

http://www.azblue.com/providers



Shield-only ID card (In certain territories, such as Hong Kong and the United Arab Emirates, Blue Cross branded products are not available. The ID cards of members in these territories will display only the Blue Shield Global logo):

ID cards from members with benefit plans from International (out of U.S.) Blue Cross Blue Shield Licensees Members from International Licensees may seek services when traveling in the U.S. Currently the International Blue Plans include:

• Costa Rica – BlueCross BlueShield of Costa Rica

• Panama – Blue Cross and Blue Shield of Panama

• Uruguay – BlueCross & BlueShield de Uruguay

The list of International Licensees may change and is updated by BCBS on a regular basis at BCBS Companies and Licensees. Below is a current example of an ID card from an International Licensee:

BlueCross & BlueShield de Uruguay ID card

For more information about the BlueCard Program, please see the BlueCard Program Provider Guide in the secure provider portal at www.azblue.com/providers.

________________________________________________________________________________ 1. GeoBlue is the trade name of Worldwide Insurance Services, LLC (Worldwide Services Insurance Agency, LLC in California and

New York), an independent licensee of Blue Cross Blue Shield Association, made available in cooperation with Blue Cross and Blue Shield companies in select service areas.

2. Bupa Global is a trade name of Bupa, the international healthcare company. Bupa is an independent licensee of Blue Cross and Blue Shield Association. Bupa Global is not licensed by Blue Cross and Blue Shield Association to sell products branded with the Blue Cross Blue Shield marks in Anguilla, Argentina, British Virgin Islands, Canada, Costa Rica, Panama, Uruguay and U.S. Virgin Islands. In Hong Kong, Bupa Global is only licensed to use the Blue Shield marks. Please consult policy terms and conditions for coverage availability.

https://www.bcbs.com/about-us/bcbs-companies-and-licensees

https://www.bcbs.com/about-us/bcbs-companies-and-licensees



Canadian Association of Blue Cross Plans Important note: The Canadian Association of Blue Cross Plans and its member plans are separate and distinct from the Blue Cross and Blue Shield Association (BCBSA) and its member plans in the United States.

Providers may occasionally see ID cards for people who are covered by a Canadian Blue Cross plan. Claims for Canadian Blue Cross Plan members are not processed through the BlueCard® Program.

Please follow the instructions of Canadian Blue Cross plans as well as instructions on their ID cards for servicing their members. Canadian Blue Cross plans are:

• Alberta Blue Cross (Northwest Territories)

• Pacific Blue Cross (British Columbia, Yukon)

• Manitoba Blue Cross (Manitoba, Nunavut)

• Medavie Blue Cross (New Brunswick, Newfoundland, Labrador, Nova Scotia, Prince Edward Island,

• Ontario Blue Cross

• Quebec Blue Cross

• Saskatchewan Blue Cross

Source: bluecross.ca

Sample of a member ID card from a licensee of the Canadian Association of Blue Cross Plans Please note: this is ID card is NOT issued by a licensee of the Blue Cross Blue Shield Association. Follow the instructions on the back of the card for eligibility and benefits inquiries, precertification and claim submission.

http://www.bluecross.ca/en/index.html


Benefit Product “Suitcase” Logos Below are various “suitcase” logos that may be displayed on member ID cards for BCBS Plans in the United States and for International Licensees licensed through the Blue Cross and Blue Shield Association (BCBSA). Member ID cards may include one of several logos identifying the type of coverage the member has and/or indicating the provider’s reimbursement level.

The appearance of a benefit product logo is not a guarantee of payment. A provider’s reimbursement is based upon a combination of what services are covered under the member’s benefit plan in conjunction with a provider’s contract(s) with BCBSAZ.

Blank (Empty) Suitcase A blank (empty) suitcase logo on the front of a member’s ID card signifies that the member has out-of-area coverage that is not a PPO product. Benefit plans that display a blank (empty) suitcase logo on ID cards include:

• Traditional/Indemnity plans • HMO (Health Maintenance Organization) plans

Always verify eligibility and benefits to access the member’s specific information and continue to submit claims to BCBSAZ.

A provider who has a PPO contract with BCBSAZ (which includes the traditional/indemnity line of business) and who provides service to an out-of-area BlueCard member (with a blank suitcase on the ID card), will be reimbursed for covered services in accordance with contracted rates for the indemnity line of business.

PPO in a Suitcase The “PPO in a suitcase” logo on the front of the member’s ID card means that the member has PPO or EPO-style benefits available for covered services received outside of their plan’s service area.

A provider who has a PPO contract with BCBSAZ and who provides service to an out-of-area BlueCard member (with a PPO suitcase logo on the ID card), will be reimbursed for covered services in accordance with the provider’s PPO contract.

PPOB in a Suitcase The “PPOB in a suitcase” logo on the front of the ID card means the member has selected a PPO product from a Blue Plan, and has access to a nationwide PPO network known as BlueCard PPO Basic. The Basic National Network of contracted providers was designed to make out-of-area in-network coverage available for state/federal exchange members, both individual and SHOP Exchange members.

Each Blue Plan has designated its most appropriate qualified PPO/EPO network(s) to be included in the national BlueCard PPO Basic network. BCBSAZ has designated the statewide PPO to be part of the BlueCard PPO Basic network.

A provider who has a PPO contract with BCBSAZ and who provides service to an out-of-area BlueCard member (with a PPOB suitcase logo on the ID card), will be reimbursed for covered services in accordance with the PPO contract.

BCBSAZ has designated the statewide PPO to be part of the BlueCard PPO Basic network. Reimbursement for covered services will be made in accordance with the provider’s PPO or Traditional contract with BCBSAZ.


No Suitcase Some BCBS Blue Plan ID cards do not have a suitcase logo. These include ID cards for:

• Medicare Complementary and Supplemental products, also known as Medigap

• Stand-alone SCHIP (State Children’s Health Insurance Programs) that are separate from a state’s Medicaid program

• Members who do not have benefits outside of their local Plan’s service area (i.e. leased network arrangements)

Government-determined reimbursement (based on region) levels apply to these products.

While BCBSAZ routes all of these claims for out-of-area members to the member’s Blue Plan, most of the Medicare Complementary or Medigap claims are sent directly from the Medicare intermediary to the member’s Blue Plan via the established electronic Medicare crossover process.


Medicaid Product ID Cards Members enrolled in a BCBS Medicaid product are issued ID cards that:

• Do not have a suitcase logo.

• Contain disclaimer language on the back of the card indicating benefit limitations for provider awareness, for example, “This member has limited benefits outside of [state name]. Providers should request eligibility/benefit information.”

BCBS Plan Medicaid ID cards do not always indicate that a member is enrolled in a Medicaid product.

Providers should always check eligibility if the ID card has a disclaimer with benefit limitations and no suitcase logo. Go to azblue.com/providers or call 1(800) 676-BLUE (2583).

Medicaid charge limitations may apply to Medicaid claims. Contact BCBSAZ for details on how this may affect provider reimbursement.

http://www.azblue.com/Providers


Medicare Advantage Product ID Cards While BCBSAZ has a Medicare Advantage HMO, we do not participate in any Medicare Advantage PPO Network-sharing arrangements, and contracted provider reimbursement is based on the contracted rate with the member’s Blue Plan. Non-contracted provider reimbursement is the Medicare allowed amount based on where services are rendered.

When the logos below are displayed on the front of a member’s ID card, it indicates the coverage type the member has in his/her Blue Plan service area or region. However, when the member receives services outside his/her Blue Plan service area or region, provider reimbursement for covered services is based on the Medicare allowed amount, except in the case of PPO network-sharing arrangements.

Note: Member ID cards for Medicare Advantage products will display one of these benefit product logos.

Health Maintenance Organization

Medical Savings Account

Private Fee-For-Service

Point of Service

Network Sharing Preferred Provider Organization.

Sample of a BlueCard card for a member with an out-of-area Medicare Advantage benefit plan

While all MA PPO members have suitcases on their ID cards, some have limited benefits outside of their primary carrier’s service area. Providers should check the back the member’s ID card to see if any restrictions apply.


BCBSAZ Advantage Product ID Cards BCBSAZ Advantage provider network and BCBSAZ Advantage members Providers who have a separate contract with BCBSAZ Advantage and treat a BCBSAZ Advantage member, will receive the contracted rate. Providers who do not have a contract with BCBSAZ Advantage will receive reimbursement for covered services based on the Medicare allowed amount.

Sample of a BCBSAZ Advantage ID card Please note: the prefix for all BCBSAZ Advantage benefit plans is XBU.

Medicare charge limitations may apply to Medicare Advantage claims. Contact BCBSAZ Advantage at 1 (800) 446-8331 or visit www.azbluemedicare.com for details on how this may affect provider reimbursement.


Consumer-Directed Healthcare and Healthcare Debit Cards Members who have Consumer-Directed Healthcare (CDHC) plans often carry healthcare 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). All three are types of tax-favored accounts often offered by the member’s employer to pay for eligible expenses not covered by the health plan.

Some cards are “stand-alone” debit cards that cover eligible out-of-pocket costs, while others also serve as a health plan member ID card. These debit cards can help simplify the administration process and can potentially help: • Reduce bad debt • Reduce paperwork for billing statements • Minimize bookkeeping and patient account functions for handling cash and checks • Avoid unnecessary claim payment delays

In some cases, the card will display the Blue Cross and Blue Shield trademarks, along with the logo from a major debit card such as MasterCard® or Visa®.

Sample of a stand-alone healthcare debit card

Sample of a combined healthcare debit card and member ID card

Providers may swipe a combined ID/debit card to collect only the member’s cost-share amount (i.e., copayment). Please do not use the card to process full payment up front. With stand-alone healthcare debit cards, members can pay for copayments and other out-of-pocket expenses by using the provider’s debit card swipe terminal. The funds will be deducted automatically from the member’s appropriate HRA, HSA or FSA account.


• Using the member’s current member ID number, including prefix, carefully determine the member’s financial responsibility before processing payment. Check eligibility and benefits electronically through azblue.com or by calling 1 (800) 676-BLUE (2583).

• All services, regardless of whether or not the member responsibility was collected at the time of service, must be billed to BCBSAZ for proper benefit determination, and to update the member’s claim history.

• Please do not use the card to process full payment up front. For questions about the member’s benefits, contact 1 (800) 676-BLUE (2583) or, for questions about the healthcare debit card processing instructions or payment issues, please contact the toll-free debit card administrator’s number on the back of the card.

bcbsaz quick guide to blue cross and blue shield id cards

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