BlueCard® is a national program that enables members of a Blue Plan to get health care services while traveling or living in another Blue Plan's service area. Currently, the responsibility for getting precertification is the member’s for inpatient facility services.
Effective July 1, 2014, you will be responsible for getting prior authorization for inpatient facility services for out-of-area members. The member will not be responsible when prior authorization is required but not received for inpatient services. BlueCard members will now be treated the same as local BlueCross Plan members.
Failure to get necessary prior authorizations will result in claim penalties or denials. Here’s what you should know:
You must also:
Contact information to get prior authorization for a member’s Plan is on the identification card. You can also verify authorization requirements by:
Thank you for your attention to this policy change. We encourage you to share this message with everyone in your office.
Please contact Provider Education for information about this bulletin at firstname.lastname@example.org or by calling 803-264-4730.