BlueCard Program Creating Overlapping Service Area
October 25, 2022
Starting Nov. 1, BlueCross BlueShield of Tennessee is offering group health plans in Catoosa, Dade, and Walker counties in Georgia. These counties will become overlapping service areas. An overlapping service area is formed when multiple plans share the same service area. BlueCard cannot be utilized for the plans servicing these counties after Nov. 1, 2022.
- BCBST members seen in Catoosa, Dade or Walker counties must be filed to BCBST.
- Anthem members seen in Catoosa, Dade or Walker counties must be filed to Anthem Georgia.
Georgia counties contiguous to BCBS TN’s service area are Murray, Whitfield, Fannin, Chattooga (new), Floyd (new) and Gordon (new).
File to Tennessee if:
- BCBS TN member – Tennessee provider or contiguous provider – contracted with Tennessee
- BCBS TN member – Tennessee provider or contiguous provider – contracted with both plans
- BCBS TN member – overlapping service area county provider.
- Note: It does not matter if the provider is contracted with both BCBS TN and Anthem Georgia. The claim should be filed to Tennessee.
- Host member – Tennessee provider contracts with Tennessee and services were in Tennessee
- Non-Anthem host member – overlapping service area county provider – provider contracts with BCBS TN
File to Local Plan if:
- Non-Anthem host member – overlapping service area county provider – provider doesn’t contract with BCBSTN but is contracted with Anthem Georgia
- Anthem host member – overlapping service area county provider
- Host member services were rendered outside of Tennessee and out of the overlapping service area, even if the provider is contracted with Tennessee (e.g., Whitfield or Chattooga counties), claim should be filed where services were rendered
- Contiguous county doesn’t apply for host members. These claims would be considered out of state.
For more details, refer to the BlueCard section of the Provider Administration Manual here.