BlueCard links participating health-care providers and the independent Blue Cross and Blue Shield Plans across the country through a single electronic network for professional outpatient and inpatient claims processing and reimbursement. The program allows participating Blue Cross and Blue Shield providers in every state to submit claims to their local Blue Cross and Blue Shield Plan for members enrolled with another Blue Plan or affiliated company such as Health Advantage, which is affiliated with Arkansas Blue Cross Blue Shield.
Through the BlueCard program, out of state providers can submit claims for Health Advantage members they are treating directly to Health Advantage electronically through their local Blue Plan. If you are an Arkansas provider, Health Advantage is your sole necessary contact for claims submissions, payments, adjustments, services and inquiries.
BlueCard applies to inpatient, outpatient and professional services. BlueCard does
not yet apply to the following:
When members from other Blue Cross and Blue Shield Plans arrive at your office or facility, be sure to ask them for their current membership ID card. The two main identifiers for BlueCard members are the alpha prefix for Health Advantage, which is XCH for example and the "suitcase" logo.
The three-character alpha prefix at the beginning of the member's identification number is the key element used to identify and correctly route out-of-area BlueCard claims. The alpha prefix identifies the Plan or national account to which the member belongs.
Call 1-800-676-BLUE (2583).
With the member's most current ID card in hand, you can check available membership and coverage information by calling BlueCard Eligibility® at 1-800-676-BLUE (2583). An operator will ask you for the alpha prefix on the member's ID card and will connect you to the appropriate membership and coverage unit at Health Advantage.
Providers should remind patients from Health Advantage that they are responsible for obtaining precertification or preauthorization for coverage of their services. You also may choose to contact Health Advantage on behalf of the member. If you choose to do so, refer to the precertification or preauthorization phone number on the back of the member's ID card.
The Health Advantage Coverage Policy is available on the Provider page of this website.
If you are an Arkansas provider or contract with Health Advantage and are located in a contiguous area, always submit BlueCard claims electronically through AHIN or mail to Health Advantage, P.O. Box 2181, Little Rock, AR 72203-2181.
Be sure to include the member's complete ID number when you submit the claim. The complete ID number includes the three-character alpha prefix. Do not make up alpha prefixes. Incorrect or missing alpha prefixes and member identification numbers delay claims processing.
After Arkansas Blue Cross receives a claim, it will electronically route the claim to the member's Blue Cross and Blue Shield Plan. The member's Plan then processes the claim and approves payment or provides an explanation why a service is not covered, and Arkansas Blue Cross will remit payment based on the Arkansas Blue Cross applicable fee schedule, and the member's benefits from the other Blue Plan or provide information as to why the service was not eligible.
The claim submission process for international Blue Cross and Blue Shield members is the same as for domestic Blue Cross and Blue Shield members.
If you are a health-care provider who offers products, materials, informational reports and remote analyses or services and are not present in the same physical location as a patient, you are considered an indirect, support or remote provider. Examples include, but are not limited to, prosthesis manufacturers, durable medical equipment suppliers, independent or chain laboratories or telemedicine providers.
If a member contacts you, tell the member to contact Health Advantage. Refer them to the front or back of their ID card for a customer-service number.
Please note that Health Advantage does not share ownership or governance with any other Blue Cross and Blue Shield Plan; Health Advantage is an entirely independent, separate for-profit company, organized in the State of Arkansas and owned by its shareholders. The only association between Health Advantage and other Blue Cross and Blue Shield Plans is that each separate company has been licensed by the Blue Cross and Blue Shield Association to use the registered "Cross" and "Shield" service marks in their separate business operations.
The BlueCard Program is a cooperative effort among these separate, independent licensees of the Blue Cross and Blue Shield Association but it does not in any way obligate Health Advantage to fund any benefits or become liable for any activities or omissions of any other Blue Cross and Blue Shield Plan. If you dispute the coverage or payment determination of another Blue Cross and Blue Shield plan, you must pursue appeals or other legal remedies with the applicable Blue Cross and Blue Shield Home Plan, not with Health Advantage.
Health Advantage is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties in Arkansas. Copyright © 2002-2017 HMO Partners, Inc.