[
Through the BlueCard Program, providers can render services to patients who
(1) are enrolled in a Blue Cross® and Blue
Shield® plan other than one offered by Independence and (2)
present to physicians in the Independence five-county service area (i.e.,
Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) for
treatment.
There are two BlueCard PPO professional networks within the Independence
five-county service area:
- Personal Choice® (Independence?s PPO network)
- Premier Blue (Highmark Blue Shield?s PPO network)
Professional providers who are contracted with both of these PPO networks
may submit claims to either Independence or Highmark Blue Shield, except for
the following:
- Providers who hold a professional contract with Independence and not
Highmark Blue Shield should submit professional claims to Independence
directly.
- Providers should continue to submit professional claims to Highmark Blue
Shield for Traditional Indemnity members and HMO members (for urgent/emergent
situations) enrolled in a Blue Cross and Blue Shield plan other than one
offered by Independence.
- Professional providers who are contracted with other area health plans
(e.g., Highmark Blue Shield, Highmark Blue Cross Blue Shield of Delaware,
Capital Blue Cross, Horizon Blue Cross Blue Shield of New Jersey) must submit
claims to the applicable contracted health plan when treating members from
those plans.
All members who present for service are subject to eligibility verification
and the applicable precertification requirements of their Home Plan.
If you have any questions related to this article, please contact your
Network Coordinator.
Updated Payer ID grids available soon
The Payer ID grids will be updated in early June based on the
information in this article. You will be able to download the latest versions
from our Electronic Data Interchange (EDI) webpage to ensure that
your office is using the most up-to-date information for claim submissions.
Announcements will be made on Independence NaviNet® Plan Central
and on our Provider News Center once the updated Payer ID grids are
available.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.