This chapter provides information about BlueCard and Shared Administration out-of-area claims. Shared administration is a business arrangement between multiple parties in the delivery and administration of healthcare benefits. Additional resources include our BlueCard Resources page, BlueCard web-based training in our Learning Center, and the Shared Administration contact list.
There can be an exception to the claims submission process for providers who practice in a county contiguous to another Blues plan, or in a county with overlapping Blues plans.
The back of the member's ID card states to submit claims to your “local” Blues plan. In some instances, this also means “contracted” if you are contracted with the member's plan. Submitting claims to your “local” Blues plan is correct for most states, except in the case of Idaho and Oregon providers, because Premera's service area overlaps with another Blue plan.
For more assistance, including information on where to submit your claims, see the plan prefix list on the BlueCard Resources page on our website. (OneHealthPort access is required to view the list.)
All BlueCard® claims processed by Premera will be paid according to the terms of your contract with Premera Blue Cross.
Claims for the Federal Employee Program (FEP) are exempt from the BlueCard Program. Please follow your FEP billing guidelines.
Shared Administration is one option for Premera to sell healthcare coverage to employees of national companies in our area. Shared Administration also allows Premera to serve accounts for other Blue Cross and/or Blue Shield (BCBS) plans whose members work away from their company headquarters. Not all Blue Cross and/or Blue Shield national accounts are administered on the Shared Administration system.
Participating physicians and other providers should submit claims to Premera for services provided to Shared Administration members. Shared Administration ID cards have Blue Cross and/or Blue Shield plan instructions for mailing claims.
Three characters precede the subscriber ID number. It's important that all claims contain the complete subscriber ID number in Box 1A of the CMS-1500 form. The back of the member's ID card provides information for claims submission. We encourage you to ask for a copy of each patient's ID card at every visit to ensure that you have the most current information for billing and inquiry purposes. View the Shared Administration contact list for group names, prefixes, and contact information for member eligibility/benefits, and prior authorization.
Premera will process and pay the claims, and create the voucher and remittance advice notices. The Premera Blue Cross name and address will appear in the heading of these notices. The differences between charges submitted and allowed charges are considered contractual adjustments. Physicians and other providers may bill members only for the difference between allowed charges and the amount paid, which is the patient liability, coinsurance or deductible.
Physicians and other providers submitting claims electronically should include Shared Administration member claims with their Premera claims. The 12-character subscriber ID number tells the system to recognize the claim as Shared Administration. Customer service is available for Shared Administration accounts at 800-713-5373.
To expedite overpayment adjustments, the Premera National Accounts department has a process that automatically recoups identified overpayments. This allows physician and other provider offices to settle account receivables sooner.
The process is as follows:
If the amount is:
The Shared Administration system also houses many self-funded groups. These groups pay claims out of their own bank accounts ─ meaning, there are different financial “accounts” within the Shared Administration system. Due to these special banking arrangements, you could see an exception to voucher deductions. Though there may be an outstanding overpayment, you could receive a full voucher payment because a voucher deduction will not cross financial accounts. The outstanding overpayment will carry forward and be deducted from a subsequent payment on the same financial account ─ this will be noted on the voucher.
Shared Administration payments are created every Friday night. All payments, regardless of financial arrangement, are made on the same voucher.
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