As a participating provider of BlueCross BlueShield of Western New York you may render services to patients who are national account members of other BlueCross and/or BlueShield Plans, and who travel or live in our service area. This manual is designed to describe the advantages of the program, while providing you with information to make filing claims easy. This manual will offer helpful information about:
We automatically cross-over Medicare claims for services covered under Medigap and Medicare Supplemental products to secondary payers so you do not need to submit an additional claim to the secondary carrier.
Do you practice in a county bordering another state? Do you have contracts with Blue Plans in your state and the neighboring state? File claims with the local Blue Plan based on where the service was provided (unless the member has coverage with the neighboring state’s Blue Plan).
Access the information you need about servicing out-of-area Blue members, including:
Out-of-Area Members: Contiguous Areas
If you operate in a contiguous area, get answers to your questions about:
BlueCard® Claims Adjustments
We have been notified by the BlueCross BlueShield Association that due to a system defect, all BlueCross and/or BlueShield plans are required to adjust BlueCard® claims that were processed during a two-week period in October, 2013.
There will be no change to your payments. This status adjustment is the plan’s responsibility and is related to the cost of claims processing between plans. The adjustments will appear on your vouchers and member Explanation of Benefits.