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BlueCard® Program Claim Filing

The BlueCard Program links participating health care providers and the independent Blue Cross and Blue Shield (BCBS) Plans across the country and around the world through a single electronic network for claims processing and reimbursement.

The program allows you to submit claims for patients from other domestic and international BCBS Plans directly to your local Blue Plan. Your local Blue Plan will be your contact for claims payment, problem resolution, adjustments, and inquiries.

BlueCard members are easy to identify

Not sure what to do when a patient hands you an identification card from another BCBS Plan?

  • Look for the three-character alpha prefix that precedes the identification number on the ID card. The alpha prefix identifies the member's BCBS Plan or national account, and it also confirms membership and coverage.

     

  • Cards that do not have an alpha prefix may indicate that claims are not handled through the BlueCard Program; please look for instructions or a telephone number on the member's ID card for how to file these claims.

     

  • BlueCard members may also have a suitcase logo located in the corner of their ID card:
    BlueCard suitcase logos

     

  • We suggest that you make copies of the ID card (front and back) and pass this key information on to your billing staff.

Three easy steps to file BlueCard claims

  1. With the member's ID card in hand, call BlueCard Eligibility® at 800-676-BLUE (2583) to verify the patient's eligibility and coverage.

     

  2. Tell the operator the first three characters (alpha prefix) of the member's ID number. The operator will then connect you directly to the appropriate membership and coverage unit at the patient's BCBS Plan.

     

  3. After the patient receives care, submit the claim to:

    Blue Cross and Blue Shield of New Mexico
    P.O. Box 27630
    Albuquerque, NM 87125-7630

To ensure prompt payment, be sure to include the patient's complete identification number, including the three-character alpha prefix. Do not make up or guess an alpha prefix. Some alpha prefixes are assigned to specific accounts, not Plans. Incorrect or missing alpha prefixes and identification numbers delay claims processing. Also, make sure you price the claim according to your contract with us, including our hold harmless agreement.

Please do not request complete payment up front. After we receive your claim, we will electronically route it to the patient's BCBS Plan. The patient's Plan then processes the claim and authorizes payment. We will then pay you according to our contract with you.


Filing Ancillary Claims

Ancillary providers include independent clinical laborary, durable/home medical equipment and supplies, and specialty pharmacy providers. These providers should submit claims as follows:

    Independent Clinical Laboratory (Lab)
  • The Plan in whose state the specimen was drawn based on the location of the referring provider.
    Durable/Home Medical Equipment and Supplies (DME)
  • The Plan in whose state the equipment was shipped to or purchased at a retail store.
    Specialty Pharmacy
  • The Plan in whose state the ordering physician is located.

Refer to the Ancillary Claims section of the BlueCard Program Provider Manual  for examples in filing ancillary claims.


Claim Status

To check claim status, please contact your local Blue Plan. If you are a Blue Cross and Blue Shield of New Mexico provider, you can also call the New Mexico Provider BlueCard Customer Service Department at 800-222-7992.

Need more information?

See the BlueCard Program Provider Manual  or frequently asked questions . View the member information about the BlueCard Program.

* If you contract with more than one Plan in a state for the same product type (i.e., PPO or Traditional), you may file the claim with either Plan.