BlueCross BlueCard Program Explained: 33 Companies... 1 Shared Network.

Описание: BlueCross BlueCard Program Explained.

The 33 Companies that are members of the BlueCross and BlueShield Association all share one nationwide network.

The BlueCard Program provides access to that nationwide network for each individual BlueCross plan.

In BlueCard, the Host Plan is the BlueCross plan were the medical service is provided. The Home Plan is the BlueCross plan that provides the member with their actual insurance coverage. Usually, the Home Plan is in the state of the headquarters of the organization providing the employer-sponsored insurance.

For example, a manufacturing company headquartered in Tennessee may have a salesperson living and working in Arizona. That employee and their family see Arizona doctors and us Arizona hospital services. In this example, BlueCross of Arizona is the Host Plan and BlueCross of Tennessee is the Home Plan.

The Host Plan 1) receives the claim from the provider, 2) determines member eligibility from the Home Plan, 3) reprices the claim, 4) applies the member's plan design from the Home Plan, 5) pays the claim and 6) receives reimbursement on the back end from the Home Plan.

The Home Plan 1) determines member eligibility, 2) maintains the member plan designs, 3) tracks accumulators for meeting deductibles and out-of-pocket maxes and 4) set coverage decisions.

But what if there is a billing problem? Who do you contact? The Host Plan? The Home Plan? It Depends...

Sources:
https://www.bcbstx.com/docs/provider/...

https://provider.excellusbcbs.com/res...

https://www.bcbsil.com/provider/claim...

https://www.beckerspayer.com/payer/10...

https://www.markfarrah.com/mfa-briefs...

https://www.cms.gov/newsroom/press-re...

https://www.bcbs.com/about-us/blue-cr...

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