Program section on the Blue Cross and Blue Shield of New Mexico Provider website at bcbsnm/pdf/provider_ref_manual/prov_man_toc.pdf .
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Quick Guide to Blue Cross and Blue Shield Member ID Cards A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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Page 2 Introduction This guide offers an overview of Blue Cross and Blue Shield (BCBS) ID cards, including what the symbols mean and how to use the information on them. When BCBS members arrive at your office or facility, ask to see their current member identification cards at each visit. Doing so will help you: Identify the member™s product. Obtain health plan contact information. Speed claims processing. Remember : ID cards are for identification purposes only; they do not guarantee eligibility or payment of your claim. You should always verify pat ient eligibility by calling 800 -676 -BLUE (2583) . The following information is provided to assist your Plan with provider education about Medicare Advantage and inter -Plan business. While the information is believed to be accurate, you should review it carefully to make sure it is appropriate for use by your Plan. Please exercise caution when us ing the provider materials. Note that some areas of the materials may require cus tomization with your Plan information, as indicated in parentheses and/or bold, and that discretion should be used regarding necessary changes and/or modifications to this material. This information does not constitute, and is not intended as, legal or fin ancial advice. Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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Alpha Prefixes Most B lue Cross and Blue Shield (BCBS) branded ID cards display a three -character alpha prefix in the first three positions of the member™s ID number. However, there are some exceptions. ID cards for the following products and programs do not have an alpha prefix: Stand -alone vision and pharmacy when delivered through an intermediary model* Stand -alone dental products* The BCBS Federal Employee Program (FEP) Œ The letter fiRfl appears in front of the ID number.* *Follow instructions on these ID cards to verify eligibility, submit claims and obtain health plan contact information. The alpha prefix is critical for inquiries regarding the member, including eligibility and benefits, and is necessary for proper claim filing. When filing a claim, always enter the ID number, including the alpha prefix, exactly as it appears on the member™s card. Always include the member™s ID number, including the alpha prefix, on any documents pertaining to services to ensure accurate handling by the BCBS Plan. A member™s ID number includes the alpha prefix in the first three positions and all The following are examples of ID numbers with the alpha prefix highlighted: Alpha Prefix ABC1234567 Alpha Prefix ABC1234H567 Alpha Prefix ABCD1234H567 Alpha Prefix ABCD1234H56789012 Page 3 Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (Empty) Suit case PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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Member ID Card Below is an example of a B lue Cross and Blue Shield (BCBS) ID card with the alpha prefix highlighted: TIPS FOR SUCCESS Always use the alpha prefix on the member™s current ID card. If there is no alpha prefix, do not create one or use an alpha prefix from another member™s ID card, even one from the same BCBS Plan. Doing so may cause delays in the handling of your inquiries and claims. If the card presented has no alpha prefix, follow the instructions on the back of the ID card for inquiries and claim handling. Page 4 Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Card s Benefit Product Logos Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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Federal Employee Program ID Cards Federal Employee Program (FEP) members™ ID cards do not have a three -character alpha prefix. Rather, all FEP member identification numbers begin with the letter “R.” For additional information regarding FEP and FEP ID cards, please refer to the FEP docume ntation provided separately to you in the Blues Provider Reference Manual located in the Federal Employee Program section on the Blue Cross and Blue Shield of New Mexico Provider website at http://www.bcbsnm.com/pdf/provider_ref_manual/prov_man_toc.pdf . Below is an example of an FEP Basic ID card with the fiRfl highlighted: Below is an example of an FEP Standard ID card with the fiRfl highlighted: Page 5 Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Card s Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos
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ID Cards from International Licensees Occasionally, you may see ID cards from members of International Licensees. Currently those Licensees include Blue Cross and Blue Shield of the U.S. Virgin Islands, BlueCross & BlueShield of Uruguay, Blue Cross and Blue Shield of Panama, Blue Cross Blue Sh ield of Costa Rica and GeoBlue. If in doubt, always check with Blue Cross and Blue Shield of New Mexico (BCBSNM) , as the list of International Licensees may change. ID cards from these Licensees will also contain three -character alpha prefixes and may or m ay not have one of the benefit product logos referenced in the following sections. Please treat these members as you would domestic BCBS members (e.g., do not collect any payment from the member beyond cost -sharing amounts, such as deductible, coinsurance and copayment) and file their claims to BCBSNM . Below is an example of an ID card from an International Licensee with the alpha prefix highlighted: Page 6 Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos
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Benefit Product Logos Various logos may be displayed on member ID cards for B lue Cross Blue Shield (BCBS) Plans in the United States and International Licensees licensed t hrough BCBSA. Member ID cards may include one of the logos below that identify the type of coverage the member has and/or indicate the provider™s reimbursement level. TIPS FOR SUCCESS The appearance of a benefit product logo is not a guarantee of payment. A provider™s reimbursement is based on a combination of the services covered under the member™s benefit plan in conjunction with a provider™s contract(s) with Blue Cross and Blue Shiel d of New Mexico (BCBSNM) . Page 8 Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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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 products that di splay a blank (empty) suitcase logo on ID cards include: Traditional and Health Maintenance Organization (HMO) Point of Service (POS) Traditional, HMO and Limited Benefit Products Members Contracted Blue Cross and Blue Shield of New Mexico (BCBSNM) traditional/indemnity providers (benefit products listed above) including non contracted providers who provide medical service to a member who has a blank suitcase logo on his/her member ID card (local member or out -of-area member) will be reimbursed for s ervices covered under the member™s benefit plan, in accordance with the traditional/indemnity contract. Patient eligibility and benefits should be verified prior to every scheduled appointment. Eligibility and benefit quotes include membership verification, coverage status and other important information, such as applicable copayment, coinsurance and deducti ble amounts. It™s strongly recommended that providers ask to see the member™s ID card for current information and photo ID in order to guard against medical identity theft. When services may not be covered, members should be notified that they may be bille d directly. Checking Online Providers are strongly encouraged to use availity.com or their preferred vendor for eligibility and benefit verifications. With Availity™s Eligibility and Benefits Inquiry, users can access printable results that include up to d ate benefit information. If you don™t have a traditional/indemnity contract with Blue Cross and Blue Shield of New Mexico (BCBSNM) and provide medical service to a member who has a blank suitcase logo on his/her member ID card (local member or out -of-area member), you will be reimbursed for services covered under the member™s benefit plan as defined by the health plan™s terms . Page 9 Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (Empty) Suit case PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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Point of Service (P OS) Members If you have a POS contract with Blue Cross and Blue Shield of New Mexico (BCBSNM) and provide medical service to a member who has a blank suitcase logo on his/her member ID card (local member or out -of-area member) and a POS product, you will be reimbursed for services covered under the member™s benefit plan, in accordance with the POS contract. If you don™t have a POS contract with BCBSNM and provide medical service to a member who has a blank suitcase logo on his/her member ID card (local member or out -of-area member) and a POS product , you will be reimbursed for services covered under the member™s benefit plan, in accordance with the traditional/indemnity contract as defined by the health plan™s terms . TIPS FOR SUCCESS Because there is different benefit plans represented by the blank (empty) suitcase logo, always verify eligibility and benefits electronically with BCBSNM or by calling 800 -676 -BLUE (2583) . Page 10 Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefi t Product Logos Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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PPO in a Suitcase When you see the fiPPO in a suitcasefl logo on the front of an ID card, it means that the member has PPO – or EPO -type benefits available for medical services received within or outside of the United States. It also means that the provider will be reimbursed for covered services in accordance with your PPO contract with the local B lue Cross Blue Shield (BCBS) Plan. TIPS FOR SUCCESS If you do not have a PPO contract with Blue Cross and Blue Shield of New Mexico (BCBSNM) , reimbursement for covered services will be made in accordance with your non -PPO contract with BCBSNM . To be certain of a member™s benefit level, always verify eligibility and benefits electronically with BCBSNM or by calling 800 -676-BLUE (2583) . PPO Œ Preferred Provider Organization Plan EPO Œ Exclusive Provider Organization Plan PPOB in a Suitcase When you see the fiPPOB in a suitcasefl logo on the front of an ID card, it means the member has selected a PPO/EPO product from a BCBS Plan and the member has access to BlueCard PPO Basic. TIPS FOR SUCCESS If you do not have a PPOB contract with BCBSNM , reimbursement for covered services will be made in accordance with your PPO or Traditional contract with BCBSNM . To be certain of a member™s benefit level, always verify eligibility and benefits electronically with BCBSNM or by calling 800 -676 -BLUE (2583) . PPO Œ Preferred Provider Organization Plan EPO Œ Exclusive Provider Organization Plan Page 11 Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (Empty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards Introduction Alpha Prefixes Federal Employee Program ID Cards ID Cards from International Licensees Canadian ID Cards Benefit Product Logos Blank (E mpty) Suitcase PPO in a Suitcase PPOB in a Suitcase No Suitcase Medicare Advantage Consumer -Directed Healthcare and Healthcare Debit Cards
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