Name of Manual - Blue Cross and Blue Shield of Minnesota

Table of Contents
Chapter 7
BlueCard ®
BlueCard Introduction .............................................................................................................. 7-3
Overview................................................................................................................................7-3
Identifying BlueCard ® Members ...........................................................................................7-3
Definitions.............................................................................................................................. 7-7
How the Program Works .......................................................................................................7-7
BlueCard Service ....................................................................................................................... 7-8
Claims Questions ...................................................................................................................7-8
Benefits and Eligibility ..........................................................................................................7-9
BlueCard Preferred Provider Organization (PPO).................................................................7-9
Prior Authorization and Preadmission Notification.............................................................7-10
BlueCard Claims...................................................................................................................... 7-11
Claims Submission...............................................................................................................7-11
Exclusions............................................................................................................................7-11
Electronic Data Interchange (EDI) Submission...................................................................7-12
Paper Submission.................................................................................................................7-12
Coding.................................................................................................................................. 7-12
Medical Records ..................................................................................................................7-12
Managed Care ......................................................................................................................7-12
Claims Processed by Blue Cross............................................................................................. 7-13
Claims Notification..............................................................................................................7-13
Policies.................................................................................................................................7-13
Adjustments .........................................................................................................................7-13
Claims Processed by the Member’s Plan............................................................................... 7-14
Claims Notification..............................................................................................................7-14
Policies.................................................................................................................................7-14
Adjustments .........................................................................................................................7-14
Appeals ................................................................................................................................7-14
Medical Records....................................................................................................................... 7-15
Overview..............................................................................................................................7-15
Coordination of Benefits (COB) Claims ................................................................................ 7-17
Guidelines ............................................................................................................................7-17
Claim Payment......................................................................................................................... 7-18
Guidelines ............................................................................................................................7-18
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/30/10) 7-1