Blue Cross Blue Shield Association for each state in the US

 

 

 

 

 

 

 

The exception to the rule are California, Illinois, New York, Pennsylvania and Washington as in each of the state, they have more than one Blue Cross and Blue Shield organization.

Is an association of 36 separate US health insurance organizations and companies.  Generally speaking, Blue Cross is separate in each state. Excluding in California, Illinois, New York, Pennsylvania and Washington (separate companies that operate within the state.)  As a general rule, a provider submit claims to their local Blue Cross, whether you are credentialed or not.

Where do I submit claims?

You submit all claims to your local Blue Cross.  If, you live in Florida, you submit to your Florida Blue Cross.  For Blue Cross, you are to submit the claims to you local Blue Cross, no matter of the name of the Blue Cross company on the card.

Example, if you live in the state of Florida , and you patient has a card that was issued in the state of Michigan.  You are to submit the claims to Florida Blue Cross. This is under the BlueCard Program (see below.)

What is the BlueCard Program?

The BlueCard program is the national program for Blue Cross that allows members to obtain services outside the originating area of their plan. From the perspective of the provider it simplifies the submitting process. Instead of having to register with each Blue Cross in each state, you must only register or be credentialed with your local Blue Cross.  

When claims are submitted to the local Blue Cross,  they internally route the claim(s) to the originating plan for pricing.The claim(s) is priced by the originating plan and sent back to the provider’s local plan that is processing the claim(s).  The local Blue Cross issues the reimbursement, based on the determination of the originating plan.

 

Each state Blue Cross has a separate BlueCard provider service contact number.  If you call the local Blue Cross, they have to transfer you to the BlueCard representative for claim information.

 

What is the Federal Employee Program (FEP)?

Blue Cross member ID’s began with an alpha prefix, example XGH, then the remaining digits for the ID.  For the Federal Employee program is recognizable with as member ID begins with “R” followed by the digits for the member ID.

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