Filing BlueCard® ancillary claims       
Generally, claims should be filed to the local Blue Cross and Blue Shield Plan. However, there are unique circumstances when claims filing directions will differ based on the type of provider and service.

Ancillary providers are independent clinical laboratory, durable/home medical equipment and supplies, and specialty pharmacy providers. The local Blue Plan as defined for ancillary services is as follows:

  • Independent clinical laboratory (lab): The Plan in whose state* the specimen was drawn.
  • Durable/home medical equipment and supplies (DME): The Plan in whose state* the equipment was shipped to or purchased at a retail store.
  • Specialty pharmacy: The Plan in whose state* the ordering physician is located.

*If you contract with more than one Plan in a state for the same product type (e,g., PPO or traditional), you may file the claim with either Plan.

The ancillary claim filing rules apply regardless of the provider’s contracting status with the Blue Plan where the claim is filed.

Providers are encouraged to verify member eligibility and benefits by contacting the phone number on the back of the member ID card or call 800-676-BLUE before providing any ancillary service.

Providers who use outside vendors to provide services (e.g., sending blood specimens for special analysis that cannot be done by the lab where the specimen was drawn) should use in-network participating ancillary providers to reduce the possibility of additional member liability for covered benefits. You can find a list of in-network participating providers in our
Provider Finder®.

Members are financially liable for ancillary services not covered under their benefit plans. It is the provider’s responsibility to request payment directly from the member for non-covered services.

Refer to Section 4.3 of the
BlueCard Program Provider Manual for examples in filing ancillary claims. If you have any questions about where to file your claim, please contact the BCBSNM Provider Service Unit at 888-349-3706.

Blue Review • January 2012 • bcbsnm.com