BlueCard Program

Eligibility and Claims Filing Information for Out-of-State Blue Cross and Blue Shield Members

Blue Cross and Blue Shield plans nationwide process claims for one another through an electronic network called Interplan Teleprocessing Services (ITS). When you render services to a member of another Blue Cross and Blue Shield plan, HMSA's reciprocal agreements within the Blue Cross and Blue Shield Association – referred to as the BlueCard Program – allow you to submit claims directly to HMSA and receive payment for your services through HMSA, based on your participating agreement.

Identifying BlueCard Members

Although Blue Cross and Blue Shield member ID cards vary in appearance across plans, all valid ID cards display the Blue Cross and/or Blue Shield service marks.

Blue Cross and Blue Shield members who are enrolled in plans that participate in the BlueCard program are identified easily by the three-character prefix displayed at the beginning of their member ID number. HMSA member IDs are displayed on ID cards beginning with XL- or HFP (Federal Plan 87 and HMSA Plan for Postal Service Employees). Also, BlueCard member IDs have the suitcase logo displayed somewhere on the card.

If the member's card does not have the suitcase logo or a three-character prefix, they are enrolled in a plan that is exempt from the BlueCard Program. Claims for these members should be filed directly to the member's Blue Cross and Blue Shield plan.

Eligibility Verification

There are two ways you can verify out-of-state BlueCard member eligibility: by phone or through the HHIN Documents & Information. These services allow providers to obtain information about covered benefits, plan deductible amounts, copayments and more.

By phone

To verify eligibility for a particular member, call 1-800-676-BLUE (2583). The network is available Monday through Friday from 1:30 a.m. until 2 p.m. Hawaii Standard Time (when the Mainland is on daylight-saving time); or from 2:30 a.m. until 3 p.m. when the Mainland is on standard time. When you are connected with the network, simply enter member information via your touch-tone phone keys and you will be directed to the member's home plan. Scroll down for more complete instructions on how to use the automated toll-free telephone number.

Through HHIN

If you have access to HHIN, you also can verify out-of-state member eligibility electronically. HHIN is available from 1 a.m. until 7 p.m. Hawaii Standard Time when the Mainland is on daylight-saving time; 2 a.m. until 8 p.m. when on standard time. Scroll down for more details on how to use HHIN to verify BlueCard member eligibility.

These value-added services are provided by the Blue Cross and Blue Shield Association for your convenience. As a courtesy, please remind BlueCard PPO members (identified by a suitcase logo with "PPO" displayed inside, located in the upper right corner of the member ID card) that they are responsible to obtain from their home plan any necessary benefit precertifications for medical services.

How to Use the BlueCard 800# Network

All you need is a touch-tone phone and your patient's member identification number. Then follow these instructions:

• Call 1-800-676-BLUE (2583).
• Using the keypad on your phone, enter the prefix found at the beginning of the member's identification number. For your convenience, all of the alpha equivalents are listed below. (Please note that Q and Z are exceptions to the two-digit standard.)
• Press the # key after the final alpha equivalent has been entered.

Example:

Your patient's member ID begins with "MCP." You will enter:

• 61
• 23
• 71
• #

When the prefix entry has been completed, the BlueCard system will connect you with the member's Blue Cross and Blue Shield plan. Remembering the time differences between Hawaii and the Mainland, you will be more likely to reach a representative if you call early in the day. If your call is received by the Mainland plan during regular business hours, a plan representative will answer your call and assist you with eligibility verification.

How to Use HHIN

To check BlueCard eligibility through HHIN, first access the online network. Click the BLUE ELIGIBILITY button on the left side of the home page. Enter the member's information in the fields that display (they are all required), and click the SUBMIT button. It may take up to 60 seconds for your inquiry to be processed; please only click the SUBMIT button once.

If your search returns no matches, either the information you entered is incorrect or the information is correct, but the HHIN system is currently unavailable. You may re-enter the member's information, or you can verify member eligibility over the phone as outlined above.

If your search is successful, member information will display. Ensure the member's personal information (e.g., name, address, etc.) matches the member ID card. Then, review the following sections to verify member eligibility:

• Section two – Eligibility Begin Date or Eligibility Date Range: Ensure the member's coverage dates include the requested date of service.
• Section five – Benefits Coverage Information: Review basic benefit information such as the type of plan, type of coverage, and type of benefit. Click each individual line to display more information about the benefits coverage provided.

Note: Member information will display in HHIN only if the member's home plan provides these details for availability on HHIN. The information that displays will be a very basic overview of the member's plan benefits. More specific information about the member's benefits coverage can be obtained by contacting the member's home plan through the BlueCard 800# Network; however, keep in mind the phone network's hours of availability are more limited than HHIN's.

Copayment and Claims Filing Information

If the member is eligible for coverage with his or her home plan and the services meet the benefit guidelines of the patient's home plan, you should submit claims directly to HMSA. Please do not charge the patient for amounts other than any copayment the patient may owe. Participating providers who collect in full at the time of service will be responsible for refunding the patient and accepting the appropriate provider adjustment after payment is made by HMSA. If you have questions about previously processed claims, call HMSA's BlueCard Program at 808-948-6280.

When filing claims for BlueCard members, be sure to indicate the three-character prefix. This prefix is needed by HMSA to identify the home plan of the patient. Claims for services rendered to members of out-of-state Blue Cross and Blue Shield plans are filed on a CMS 1500 claim form, just as they are for HMSA members. However, there are some minor differences in the information fields that must be completed for these members. Refer to CMS 1500 Claim Form - General Instructions.

Submit claims for services rendered to out-of-state Blue Cross and Blue Shield members to:

HMSA - BlueCard Program
P.O. Box 860
Honolulu, HI 96808-0860

If you have other questions about submitting claims for services rendered to out-of-state Blue Cross and Blue Shield members, you may call HMSA's BlueCard Program at 808-948-6280 on Oahu or 1-800-648-3190 from the Neighbor Islands.

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