Alpha Prefix

 Three characters preceding the subscriber identification number on the Blue Plan ID cards.  The alpha prefix identifies the member's Blue Plan or national account and is required for routing claims.

 

bcbs.com

Blue Cross and Blue Shield Association's Web site, which contains useful information for providers.

 

BlueCard Access -1-800-810-BLUE

www.bcbs.com/healthtravel/finder.html

A toll-free 800 number for you and members to use to locate health care providers in another Blue Plan's area.  This number is useful when you need to refer the patient to a physician or health care facility in another location.

 

BlueCard Eligibility -1-800-676-BLUE

A toll-free 800 number for you to verify membership and coverage information, and obtain pre-certification on patients from other Blue Plans.

 

BlueCard PPO

A national program that offers members traveling or living outside of their Blue Cross and-or Blue Shield Plan's area the PPO level of benefits when they obtain services from a physician or hospital designated as a BlueCard PPO provider.

 

BlueCard PPO Member

Carries an ID card with a suitcase logo with PPO inside on it.  Only memvers with this identifier can access the benefits of the BlueCard PPO.

 

BlueCard Doctor & Hospital Finder Web Site

www.bcbs.com/healthtravel/finder.html

A Web site you can use to locate health care providers in another Blue Cross and/or Blue Shield Plan's area.  This is useful when you need to refer the patient to a physician or healthcare facility in another location.  If you find that any information about you, as a provider, is incorrect on the Web site, please contact the local plan.

 

BlueCard Worldwide

 A program that allows Blue members traveling or living abroad to receive nearly cashless access to cover inpatient hospital care, as well as access to outpatient hospital care and professional services from health care providers worldwide.  The program also allows members of foreign Blue Cross and/or Blue Shield Plans to access domestic (U.S.) Blue provider networks.

 

Consumer Directed Health Care/Health Plans (CDHC/CDHP)

Consumer Directed Health Care (CDHC) is a broad umbrella term that refers to a movement in the health care industry to empower members, reduce employer costs, and change consumer health care purchasing behavior.  CDHC provides the member with additional information to make an informed and appropriate health care decision through the use of member support tools, provider and network information, and financial incentives.

 

Coinsurance

A provision in a member's coverage that limits the amount of coverage by the benefit plan to a certain percentage.  The member pays any additional costs out-of-pocket.

 

Coordination of Benefits (COB)

 Ensures that members receive full benefits and prevents double payment for services when a member has coverage from two or more sources.  The member's contract language gives the order for which entity has primary responsibility for payment and which entity has secondary responsibility for payment.

 

Co-payment

A specified charge that a member incurs for a specified service at the time the service is rendered.

 

Deductible

 A flat amount the member incurs before the insurer will make any payments.

 

Hold Harmless

An agreement with a health care provider not to bill the member for any difference between billed charges for covered services (excluding coinsurance) and the amount the healthcare provider has contractually agreed on with a Blue Plan as full payment for these services. 

 

Medicare Crossover

The Crossover program was established to allow Medicare to transfer Medicare Summary Notice (MSN) information directly to a payor with Medicare's supplemental insurance company.

 

Medicare Supplemental (Medigap)

Pays for expenses not covered by Medicare.

 

National Account

An employer group that has offices or branches in more than one location but offers uniform coverage benefits to all of its employees.

 

Other Party Liability (OPL)

 A cost containment program that recovers money where primary responsibility does not exist because of another group health plan or contractual exclusions.  Includes coordination of benefits, workers' compensation, subrogation, and no-fault auto insurance.

 

Plan

Refers to any Blue Cross and/or Blue Shield Plan.