Blue Cross Blue Shield billing and credentialing
Billing and credentialing with Blue Cross Blue Shield plans in every state, including out-of-area BlueCard claims.
Working with Blue Cross Blue Shield
Blue Cross Blue Shield is a federation of more than 30 independent, locally operated companies.
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Each Blue plan sets its own policies, fee schedules and credentialing process for its area.
Patients from another state’s Blue plan are handled through the BlueCard program: you bill your local Blue plan, which coordinates with the patient’s home plan.
Plan types we bill:
- Commercial PPO, HMO and EPO
- Federal Employee Program (FEP)
- Medicare Advantage
- Medicaid plans in some states
Credentialing and enrollment
Credentialing uses your CAQH ProView profile, so it must be complete, attested within the last 120 days and authorized for the payer before the application is reviewed.
Credentialing is done with your local Blue plan.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Out-of-area members are identified by the 3-character prefix on their ID card. Claims go to your local Blue plan under BlueCard. Many Blue plans use Availity or their own portal.
Denials we prevent with Blue Cross Blue Shield
- Provider not credentialed or not linked to the group TIN
- Missing prior authorization for services on the payer’s list
- Eligibility or coordination of benefits issues
- Coding edits and bundling under payer policy
- Claims filed after the contract’s filing limit
- BlueCard claims sent to the patient’s home plan instead of the local plan
- Missing ID prefix on out-of-area claims
Questions about Blue Cross Blue Shield
A patient has a Blue card from another state. Who do we bill?
Your local Blue plan, through BlueCard, using the patient’s full ID with prefix.
Other payers and related services
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Blue Cross Blue Shield claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.