BlueCard is a program that enables members obtaining healthcare services, while traveling or living in another Plan’s service area, to receive the benefits of their Control/Home Plan* contract and to access the Par/Host Plan's* provider networks and savings. Read more in the BlueCard Specialty Claims Guide.
Program Advantages to Providers
- Equips providers with one source (Par/Host Plan) for claims submission, claims payment, adjustments and issue resolution for all BCBS members.
- Provides a centralized source and method for claims reimbursement among BCBS Plans.
Covered Services Under BlueCard
- All inpatient, outpatient and professional services
Services Not Covered Under BlueCard
- Stand-alone dental claims
- Vision and self-administered prescription drugs delivered through an intermediary model
- Medicaid and State Children’s Health Insurance Program (SCHIP)
- HMO (Health Maintenance Organization)
- Medicare Advantage
- Medigap/Medicare Complementary/Supplemental
- The Federal Employee Program (FEP)
How the BlueCard Program Works
- Identify BlueCard Members
- The PPO in suitcase indicates:
- The member is enrolled in a PPO or EPO product
- (back of card may identify benefit limitations for EPO members).
- The provider is reimbursed at the Par/Host Plan’s PPO reimbursement level.
- The PPOB in a suitcase indicates:
- The member has access to the exchange PPO network, referred to as BlueCard PPO Basic.
- The provider is reimbursed at the Par/Host Plan’s PPOB reimbursement level.
- The empty suitcase logo indicates:
- The member is enrolled in either a Traditional, HMO, POS, or Limited Benefits product.
- The provider will be reimbursed at the Par/Host Plan’s Traditional reimbursement level.
- Some BCBS ID cards must exclude the suitcase logo
- A suitcase does not appear on ID cards for BCBS members enrolled in products that are not eligible for delivery through BlueCard such as:
- Medicare Complementary/Supplemental (also known as Medigap).
- State Children’s Health Insurance Program (SCHIP).
- The three character prefix correctly routes BlueCard claims for processing (three character prefix is the first three positions of the identification number)
- The PPO in suitcase indicates:
Verify Eligibility and Benefits
Telephone: Call Blue Card Eligibility 800-676-BLUE (2583). Enter only the three-character prefix on the member's ID number and your call will be routed to the member's home plan.
Electronic: Receive real-time responses to your eligibility requests by logging on to Availity® Essentials.
Obtain Pre-certification for BlueCard Members, when applicable
Telephone: Call BlueCard Eligibility 800-676-2583 and ask to be transferred to the Medical Management Department.
Submit all BlueCard claims electronically to the Montana Plan, for faster service.
Quick Guide Outlines Member ID Card Basics
As an independently contracted BCBSMT provider, you may render services to BCBSMT members, as well as other Blue Plan members who travel or live in Montana. With the growing number of available products, plans and corresponding networks, it is increasingly important to ask for each member’s current ID card at every visit, along with a photo ID, prior to checking eligibility and benefits.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
Member ID cards are for identification purposes only and do not guarantee eligibility, benefits or payment of claims. Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the back of the member's ID card. the member's certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the back of the member's ID card.
eCare is the registered trademark of Nebo Systems.
RealMed is a registered trademark of RealMed Corporation.