Servicing Out-of-Area Members: Contiguous Areas - Blue Shield of ...

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Contiguous Area Example: Scenario FiveProvider is located in both service areas and has a contract withone Plan.• Dr. Smith has an office in GA in anarea contiguous to AL and an officein AL in an area contiguous to GA.• Dr. Smith has a contract with GA butdoes not have a contract with AL.AlabamaGeorgia• Dr. Smith sees a GA member in hisGA office. The claim is filed to GA.It is a local GA in-network claim.LocalPlanclaimA presentation of the Blue Cross and Blue Shield Association. All rights reserved.GA member26
Contiguous Area Example: Scenario FiveProvider is located in both service areas and has a contract withone Plan.• Dr. Smith has an office in GA in anarea contiguous to AL and an officein AL in an area contiguous to GA.• Dr. Smith has a contract with GA butdoes not have a contract with AL.AlabamaGeorgia• Dr. Smith sees a GA member in hisGA office. The claim is filed to GA.It is a local GA in-network claim.• Dr. Smith sees any other Planmember (IL or AL) in his GA office.The claim is filed to GA; regularBlueCard claim filing rules apply.It is a BlueCard in-network claim.HostPlan-OR-A presentation of the Blue Cross and Blue Shield Association. All rights reserved.IL memberAL member27
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Page 3 and 4: Contiguous Area Claim FilingContigu
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Remote Ancillary Providers: Scenari
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Air Ambulance Claim Filing: Example
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Servicing Out-of-Area Members: Contiguous Areas - Blue Shield of ...

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