The Advantages of BlueCard PPO
Easy Access to BlueCard PPO Providers
By linking individual preferred provider organization (PPO) networks of the Blue Cross and Blue Shield (BCBS) companies, the BlueCard® PPO Program provides members with access to one of the largest health care networks in America.
As a participant of the BlueCard PPO, you will receive the in-network benefits while receiving medical care from contracting network providers outside of Texas. Although contracting network providers may precertify those services that require precertification, it is ultimately the member's responsibility to obtain precertification by calling the appropriate number on the back of the ID card. BlueCard PPO contracting providers have agreed to accept the Blue Cross and Blue Shield of Texas (BCBSTX) allowable amount and not balance bill the member.
Our Card is Recognized Across the United States
Our BCBSTX ID card - "The BlueCard" - provides members access to BCBS network providers throughout the United States. The PPO-in-a-suitcase logo tells providers that the member is a part of the BlueCard PPO. The three-letter alpha prefix that precedes the subscriber number on the ID card identifies BCBSTX as the service area.
Usually No Paperwork or Claims to File
BlueCard PPO contracting providers have also agreed to file claims. When visiting a PPO provider, the member presents their ID card. The member will be responsible for any applicable copayment or deductible, and coinsurance amounts, in addition to any services that are not covered or not approved by BCBSTX. The physician will then file claims with the local BCBS health plan with which he or she is a contracting PPO provider. When the provider submits the claim, it is important that the three-letter alpha prefix from the ID card is included. This prefix is the key to timely and accurate claims processing.
Choosing a BlueCard PPO Contracting Provider
To get the most out of the BlueCard PPO, a PPO contracting provider should always be used. Customer Service or the BlueCard PPO Access line at 1-800-810-BLUE (2583) can help verify a BlueCard PPO provider or help locate one. If a member has a provider in mind, they can also verify that the provider participates in the local BCBS PPO.
Visiting a BlueCard PPO Contracting Provider
When visiting PPO provider, the member simply presents their ID card and reminds the provider that they are a BlueCard PPO member. Once services are rendered, the provider will file claims with the local BCBS plan with which he or she contracts.
Most providers already understand their roles and responsibilities regarding the BlueCard PPO. But in case the provider has questions, the information checklist prior to this page (entitled How BlueCard PPO Works) may be helpful. It is designed to help answer questions the provider may have regarding the BlueCard PPO.
