Revised BlueCard Process: Frequently Asked Questions
Q1: What is the revised Blue Card process and how does it differ from the previous Blue Card
process?
A1: The revised Blue Card process requires providers to verify eligibility and benefits and obtain
prior authorization from the Blue Card member’s home plan. The previous Blue Card process
required providers to obtain prior authorization from CareCentrix.
Q2: When will the revised BlueCard process be implemented and how will I be notified?
A2: The revised BlueCard process is effective May 10, 2015.
Q3: Does this change impact all FL Blue members including state, local and FEP members?
A3: No, the revised Blue Card process only impacts Blue Card members. It does not impact any
other Florida Blue members, including state, local and FEP members. For all other Florida Blue
members, providers should continue to work with CareCentrix in the same manner as they do
today.
Q4: Who should I contact if I accept a referral but am unable to service the member?
A4: If you are unable to service a patient that your agency has already accepted either from
CareCentrix or another primary referral source, please contact CareCentrix at 877-561-9910
prior to the start of care date. Additionally, providers should inform the referral source (if
different from CareCentrix) and the member’s referring physician if a delay in care will occur.
Q5: What if I’m unable to contact the referral source to communicate delays in the start of care?
A5: Contact CareCentrix immediately to communicate a possible missed start of care. Providers
should also contact the member’s referring physician to determine if an alternate start of care is
acceptable.
Q6: How should I verify member eligibility and benefits?
A6: Providers should call (800) 676-BLUE(2583), provide the 3-digit alpha prefix of the member’s
ID number, and the representative will transfer your call to the appropriate plan. Providers
should verify eligibility and benefits for the exact services needed.
Q7: Are there alternatives to contacting the home plan by phone to verify eligibility and benefits?
A7: Yes. Providers can utilize Availity to verify the member’s eligibility and benefits. However, it
is recommended that providers contact the home plan by phone to verify eligibility and benefits
for the exact services requested and determine if prior authorization is required.
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Revised BlueCard Process: Frequently Asked Questions
Q8: How do I obtain prior authorization from the home plan?
A8: There are three different ways a provider can obtain prior authorization from a home plan:
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Contact BlueCard by phone at 1-800-676-BLUE(2583) to speak with a representative
Electronically through Availity www.Availity.com
By fax request. Please contact BlueCard at 1-800-676 BLUE (2583) to determine the
appropriate fax number Important Tip: While confirming eligibility and benefits with the
home plan, ask the representative if prior authorization is required for the specific
HCPCS, and, if so, the representative can transfer you straight to the home plan’s
utilization review department.
Q9: What should I do if I am having difficulty obtaining prior authorization from the home plan?
A9: Contact the member’s home plan to obtain status on your authorization request. Encourage
the member to contact their home plan as well if the delay in obtaining the authorization is
impacting their ability to receive care. Advise the member’s physician and/or the referral source
if the delay in obtaining the authorization could cause a delay in the start of care.
Q10: If medical documentation is requested by the Blue Card home plan for prior authorization, am I
required to send it to CareCentrix or directly to the home plan?
A10: Providers should work directly with the home plan. Please follow instructions provided by
the home plan for submitting medical documentation needed to obtain prior authorization.
Please note that clinical documentation may also be required at the time of claims submission.
Documentation requested as part of claims processing should always be directed to CareCentrix
and not to the Blue Card home plan.
Q11: What if the home plan does not require prior authorization for a requested service?
A11: Providers should document the name of the representative, reference number for the call
and any other pertinent information. Services that do not require prior authorization may be
reviewed after the services are rendered. The review could result in a denial if the services are
not deemed medically necessary.
Q12: Will I still need authorization from CareCentrix for Blue Card members? What if CareCentrix is
the referral source?
A12: No. Under the revised BlueCard process, no authorizations will be issued by CareCentrix
even if CareCentrix is the referral source. Providers will work directly with the home plan to
obtain prior authorization.
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Revised BlueCard Process: Frequently Asked Questions
Q13: Will I receive any documentation if I accept a case from CareCentrix?
A13: Yes, providers will receive a service request form containing instructions to work with the
member’s home plan to verify eligibility and benefits and obtain prior authorization. The service
request form will list the requested services, but will show ‘0’ for the number of units and the
same start and stop date. Please note, the service request form is not an authorization and
does not guarantee payment for services rendered.
Q14: Should I bill CareCentrix or the member’s home plan?
A14: Providers should continue to submit Blue Card patient claims to CareCentrix.
Q15: When we verified benefits, we were told no prior authorization was required. Why has our claim
been denied for failure to obtain precertification?
A15: The provider should submit a claim reconsideration request to CareCentrix indicating that
the home plan specified that prior authorization was not required for the service rendered.
Q16: Should I work with the member directly on their out of pocket responsibility?
A16: No, the member should be directed back to their home plan if they have questions
regarding their benefit plan. For questions regarding patient out of pocket responsibility, the
member can contact the CareCentrix Patient Service Team directly at 800-808-1902 and select
option 2. This team oversees patient collections and can explain member copay and deductible
amounts. Additionally, they can answer any questions about the member’s cost share invoice.
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