Quick Guide
to Blue Cross and
Blue Shield
Member ID Cards
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Page 2
Introduction
This guide offers an overview of Blue Cross and Blue Shield (BCBS) ID cards, including what the
symbols mean and how to use the information on them.
When BCBS members arrive at your office or facility, ask to see their current member identification
cards at each visit. Doing so will help you:
• Identify the member’s product.
• Obtain health plan contact information.
• Speed claims processing.
Remember: ID cards are for identification purposes only; they do not guarantee eligibility or payment
of your claim. You should always verify patient eligibility by calling 800-676-BLUE (2583).
The following information is provided to assist your Plan with provider education about Medicare Advantage and inter-Plan business. While the information is believed to be
accurate, you should review it carefully to make sure it is appropriate for use by your Plan. Please exercise caution when using the provider materials. Note that some areas of
the materials may require customization with your Plan information, as indicated in parentheses and/or bold, and that discretion should be used regarding necessary changes
and/or modifications to this material. This information does not constitute, and is not intended as, legal or financial advice.
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Alpha Prefixes
Most Blue Cross and Blue Shield (BCBS) branded ID cards display a three-character alpha
prefix in the first three positions of the member’s ID number. However, there are some
exceptions. ID cards for the following products and programs do not have an alpha prefix:
Stand-alone vision and pharmacy when delivered through an intermediary model*
Stand-alone dental products*
The BCBS Federal Employee Program (FEP) – The letter “R” appears in front of the ID
number.*
*Follow instructions on these ID cards to verify eligibility, submit claims and obtain health plan
contact information.
The alpha prefix is critical for inquiries regarding the member, including eligibility and
benefits, and is necessary for proper claim filing.
When filing a claim, always enter the ID number, including the alpha prefix, exactly as it
appears on the member’s card.
Always include the member’s ID number, including the alpha prefix, on any documents
pertaining to services to ensure accurate handling by the BCBS Plan.
A member’s ID number includes the alpha prefix in the first three positions and all
subsequent characters ‒ between 6 and 14 numbers or letters ‒ up to 17 characters total.
The following are examples of ID numbers with the alpha prefix highlighted:
Alpha Prefix
ABC1234567
Alpha Prefix
ABC1234H567
Alpha Prefix
ABCD1234H567
Alpha Prefix
ABCD1234H56789012
Page 3
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Member ID Card
Below is an example of a Blue Cross and Blue Shield (BCBS) ID card with the alpha prefix
highlighted:
TIPS FOR SUCCESS
Always use the alpha prefix on the member’s current ID card. If there is no alpha prefix, do
not create one or use an alpha prefix from another member’s ID card, even one from the
same BCBS Plan. Doing so may cause delays in the handling of your inquiries and claims. If
the card presented has no alpha prefix, follow the instructions on the back of the ID card for
inquiries and claim handling.
Page 4
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Federal Employee Program ID Cards
Federal Employee Program (FEP) members’ ID cards do not have a three-character alpha
prefix. Rather, all FEP member identification numbers begin with the letter "R." For additional
information regarding FEP and FEP ID cards, please refer to the FEP documentation
provided separately to you in the Blues Provider Reference Manual located in the Federal
Employee Program section on the Blue Cross and Blue Shield of New Mexico Provider
website at http://www.bcbsnm.com/pdf/provider_ref_manual/prov_man_toc.pdf .
Below is an example of an FEP Basic ID card with the “R” highlighted:
Below is an example of an FEP Standard ID card with the “R” highlighted:
Page 5
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
ID Cards from International Licensees
Occasionally, you may see ID cards from members of International Licensees. Currently
those Licensees include Blue Cross and Blue Shield of the U.S. Virgin Islands, BlueCross &
BlueShield of Uruguay, Blue Cross and Blue Shield of Panama, Blue Cross Blue Shield of
Costa Rica and GeoBlue. If in doubt, always check with Blue Cross and Blue Shield of New
Mexico (BCBSNM), as the list of International Licensees may change. ID cards from these
Licensees will also contain three-character alpha prefixes and may or may not have one of
the benefit product logos referenced in the following sections.
Please treat these members as you would domestic BCBS members (e.g., do not collect any
payment from the member beyond cost-sharing amounts, such as deductible, coinsurance
and copayment) and file their claims to BCBSNM.
Below is an example of an ID card from an International Licensee with the alpha prefix
highlighted:
Page 6
Blank (Empty)
Suitcase
PPO in a Suitcase
PPOB in a Suitcase
No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Canadian ID Cards
Please note: The Canadian Association of Blue Cross Plans and its member plans are
separate and distinct from the Blue Cross Blue Shield Association (BCBSA) and its member
Plans in the United States.
You may occasionally see ID cards for members who are covered by a Canadian Blue Cross
plan. Claims for Canadian Blue Cross members are not processed through the BlueCard
®
Program.
Please follow the instructions of Canadian Blue Cross plans as well as instructions on their ID
cards for servicing their members. Canadian Blue Cross plans are:
Alberta Blue Cross
Manitoba Blue Cross
Medavie Blue Cross
Ontario Blue Cross
Pacific Blue Cross
Quebec Blue Cross
Saskatchewan Blue
Cross
Source: http://www.bluecross.ca/en/contact.html
Page 7
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Benefit Product Logos
Various logos may be displayed on member ID cards for Blue Cross Blue Shield (BCBS)
Plans in the United States and International Licensees licensed through BCBSA. Member ID
cards may include one of the logos below that identify the type of coverage the member has
and/or indicate the provider’s reimbursement level.
TIPS FOR SUCCESS
The appearance of a benefit product logo is not a guarantee of payment. A provider’s
reimbursement is based on a combination of the services covered under the member’s
benefit plan in conjunction with a provider’s contract(s) with Blue Cross and Blue Shield of
New Mexico (BCBSNM).
Page 8
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Blank (Empty) Suitcase
A blank (empty) suitcase logo on the front of a member’s ID card signifies that the member
has out-of-area coverage that is not a PPO product. Benefit products that display a blank
(empty) suitcase logo on ID cards include:
Traditional and Health Maintenance Organization (HMO)
Point of Service (POS)
Traditional, HMO and Limited Benefit Products Members
Contracted Blue Cross and Blue Shield of New Mexico (BCBSNM) traditional/indemnity
providers (benefit products listed above) including non contracted providers who provide
medical service to a member who has a blank suitcase logo on his/her member ID card (local
member or out-of-area member) will be reimbursed for services covered under the member’s
benefit plan, in accordance with the traditional/indemnity contract.
Patient eligibility and benefits should be verified prior to every scheduled appointment.
Eligibility and benefit quotes include membership verification, coverage status and other
important information, such as applicable copayment, coinsurance and deductible amounts.
It’s strongly recommended that providers ask to see the member’s ID card for current
information and photo ID in order to guard against medical identity theft. When services may
not be covered, members should be notified that they may be billed directly.
Checking Online
Providers are strongly encouraged to use availity.com or their preferred vendor for eligibility
and benefit verifications. With Availity’s Eligibility and Benefits Inquiry, users can access
printable results that include up to date benefit information.
If you don’t have a traditional/indemnity contract with Blue Cross and Blue Shield of New
Mexico (BCBSNM) and provide medical service to a member who has a blank suitcase logo
on his/her member ID card (local member or out-of-area member), you will be reimbursed for
services covered under the member’s benefit plan as defined by the health plan’s terms.
Page 9
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Point of Service (POS) Members
If you have a POS contract with Blue Cross and Blue Shield of New Mexico (BCBSNM) and
provide medical service to a member who has a blank suitcase logo on his/her member ID
card (local member or out-of-area member) and a POS product, you will be reimbursed for
services covered under the member’s benefit plan, in accordance with the POS contract.
If you don’t have a POS contract with BCBSNM and provide medical service to a member
who has a blank suitcase logo on his/her member ID card (local member or out-of-area
member) and a POS product, you will be reimbursed for services covered under the
member’s benefit plan, in accordance with the traditional/indemnity contract as defined by the
health plan’s terms.
TIPS FOR SUCCESS
Because there is different benefit plans represented by the blank (empty) suitcase logo,
always verify eligibility and benefits electronically with BCBSNM or by calling 800-676-BLUE
(2583).
Page 10
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
PPO in a Suitcase
When you see the “PPO in a suitcase” logo on the front of an ID card, it means that the
member has PPO- or EPO-type benefits available for medical services received within or
outside of the United States. It also means that the provider will be reimbursed for covered
services in accordance with your PPO contract with the local Blue Cross Blue Shield (BCBS)
Plan.
TIPS FOR SUCCESS
If you do not have a PPO contract with Blue Cross and Blue Shield of New Mexico
(BCBSNM), reimbursement for covered services will be made in accordance with your non-
PPO contract with BCBSNM. To be certain of a member’s benefit level, always verify
eligibility and benefits electronically with BCBSNM or by calling
800-676-BLUE (2583)
.
PPO – Preferred Provider Organization Plan
EPO – Exclusive Provider Organization Plan
PPOB in a Suitcase
When you see the “PPOB in a suitcase” logo on the front of an ID card, it means the member
has selected a PPO/EPO product from a BCBS Plan and the member has access to
BlueCard PPO Basic.
TIPS FOR SUCCESS
If you do not have a PPOB contract with BCBSNM, reimbursement for covered services will
be made in accordance with your PPO or Traditional contract with BCBSNM. To be certain
of a member’s benefit level, always verify eligibility and benefits electronically with BCBSNM
or by calling 800-676-BLUE (2583).
PPO – Preferred Provider Organization Plan
EPO – Exclusive Provider Organization Plan
Page 11
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
No Suitcase
Some BCBS ID cards do not have a suitcase logo. These include ID cards for Medicaid
(State Children’s Health Insurance Programs [SCHIP] administered as part of a state’s
Medicaid program), Medicare complementary and supplemental products (also known as
Medigap), and ID cards for members who do not have benefits outside of their local Plan’s
service area.
TIPS FOR SUCCESS
While Blue Cross and Blue Shield of New Mexico (BCBSNM) routes all of these claims for
out-of-area members to the member’s BCBS Plan, most Medicare complementary or
Medigap claims are sent directly from the Medicare intermediary to the member’s BCBS
Plan via the established electronic Medicare crossover process.
Medicaid Members
Members enrolled in a BCBS Medicaid product are issued ID cards that:
Do not have a suitcase logo.
Contain disclaimer language on the back of the card indicating benefit limitations for
provider awareness, for example, “This member has limited benefits outside of [state
name]. Providers should request eligibility/benefit information.”
BCBS Plan Medicaid ID cards do not always indicate that a member is enrolled in a Medicaid
product.
Providers should submit an eligibility inquiry if the ID card has a disclaimer with benefit
limitations and no suitcase logo, using the same tools that are available for BlueCard:
BlueCard Eligibility Line
BlueExchange
TIPS FOR SUCCESS
Medicaid charge limitations may apply to Medicaid claims. Contact Blue Cross and Blue
Shield of New Mexico (BCBSNM) for details on how this may affect your reimbursement.
Page 12
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Medicare Advantage
ID Cards
Member ID cards for
Medicare Advantage
products display one
of the benefit
product logos shown
here.
Health Maintenance Organization
Medical Savings Account
Private Fee-for-Service
Point of Service
Network Sharing Preferred Provider Organization.
When one of these logos is displayed on the front of a member’s ID card, it indicates the
coverage type the member has in his/her BCBS Plan service area or region. However, when
the member receives services outside his/her BCBS Plan service area or region, provider
reimbursement for covered services is based on the Medicare-allowed amount, except in the
case of PPO network-sharing arrangements.
Blue Cross and Blue Shield of New Mexico (BCBSNM) participates in Medicare Advantage
PPO network-sharing arrangements, and contracted provider reimbursement is based on the
contracted rate with BCBSNM. Non-contracted provider reimbursement is the Medicare-
allowed amount based on where services are rendered.
TIPS FOR SUCCESS
While all Medicare Advantage PPO members have suitcases on their ID cards, some have
limited benefits outside of their primary carrier’s service area. Providers should refer to the
back of the member’s ID card for language indicating that such restrictions apply.
Page 13
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Medicare Advantage Provider Network ‒ BCBSNM
Members
If you treat a Blue Cross and Blue Shield of New Mexico (BCBSNM) member and have a
contract for that member’s product, then you will receive your contracted rate. If you do not
have a contract for the member’s product, then you will receive reimbursement for covered
services based on the Medicare-allowed amount.
Out-of-Area Members
If you are contracted for Medicare Advantage PPO, then you will receive your contracted rate
when you treat any BCBS member with a Medicare Advantage PPO logo on his/her ID card.
If you are not contracted for Medicare Advantage PPO, then you will receive the Medicare-
allowed amount for covered services when you treat Medicare Advantage PPO members. If
you are contracted for Medicare Advantage PPO and you treat members who have other
Medicare Advantage products, you will receive the Medicare-allowed amount for covered
services.
Important note: If you are contracted for BCBS PPO members but not contracted for Medicare Advantage
PPO, you will receive the Medicare-allowed amount for covered services.
TIPS FOR SUCCESS
Medicare charge limitations may apply to Medicare Advantage claims. Contact your
BCBSNM Network Services Department office for details on how this may affect your
reimbursement.
Albuquerque: (505) 837-8800
Toll-free: (800) 567-8540
Page 14
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Consumer-Directed Healthcare and Healthcare
Debit Cards
Members who have Consumer-Directed Healthcare (CDHC) plans often carry healthcare
debit cards that allow them to pay for out-of-pocket costs using funds from their Health
Reimbursement Arrangement (HRA), Health Savings Account (HSA) or Flexible Spending
Account (FSA). All three are types of tax-favored accounts often offered by the member’s
employer to pay for eligible expenses not covered by the health plan.
Some cards are “stand-alone” debit cards that cover eligible out-of-pocket costs, while others
also serve as a health plan member ID card. These debit cards can help you simplify your
administration process and can potentially help:
Reduce bad debt.
Reduce paperwork for billing statements.
Minimize bookkeeping and patient account functions for handling cash and checks.
Avoid unnecessary claim payment delays.
In some cases, the card will display the Blue Cross and Blue Shield trademarks, along with
the logo from a major debit card, such as MasterCard
®
or Visa
®
.
Below is an example of a stand-alone healthcare debit card (front & back):
Page 15
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
Consumer-Directed Healthcare and Healthcare
Debit Cards and Member ID Cards
Below is an example of a combined healthcare debit card and member ID card (front & back):
Members can pay for copayments and other out-of-pocket expenses by swiping the card
though any debit card swipe terminal. The funds will be deducted automatically from the
member’s appropriate HRA, HSA or FSA account.
TIPS FOR SUCCESS
Use the member’s current ID number, including alpha prefix, to determine the member’s
financial responsibility before processing payment. Check eligibility and benefits
electronically through Blue Cross and Blue Shield of New Mexico (BCBSNM) or by
calling 800-676-BLUE (2583).
Regardless of whether or not you collect the member’s payment at the time of service, all
services must be billed to BCBSNM to determine proper benefits and update the
member’s claim history.
Please do not use the card to process full payment up front. If you have any questions
about the member’s benefits, please contact 800-676-BLUE (2583).
For questions about healthcare debit card processing instructions or payment issues, please
contact the toll-free debit card administrator’s number on the back of the card.
Page 16
Introduction Alpha Prefixes
Federal Employee
Program ID Cards
ID Cards from
International Licensees
Canadian
ID Cards
Benefit
Product Logos
Blank (Empty)
Suitcase
PPO in a Suitcase PPOB in a Suitcase No Suitcase
Medicare
Advantage
Consumer-Directed
Healthcare and Healthcare
Debit Cards
