Termination of the BlueCard Program Runs Afoul of State and Federal Regulations

For months Lab Industry groups have struggled without success to persuade BCBS representatives to meet with stakeholders and discuss the administrative/regulatory implications of non-standard claims filing rules imposed by BCBS associated with the termination of the BlueCard program. Stakeholders also stressed the access of services issue for beneficiaries, but Blue plans appear to be reassured by exclusive providers and hardened to the message. Undoubtedly, they also fall back on their ability to accept out of network claims as a last resort.

The common message to labs and lab groups from the BCBS Association is that the 39 Blue plans are independent entities and the termination of the BlueCard program simply reinforces the requirement for providers to contract with the plans in which they participate. It is unclear how the Blue plans reconcile that message with compelling labs to bill the plan in the region where the specimen was drawn as opposed to the plan with which the beneficiary is contracted. This would be akin to suggesting an Aetna patient’s claim be billed to UHC simply because the patient received a service from a provider contracted with UHC in that region.

The BCBS Association while asserting the independence of the plans, has introduced a completely new set of complex rules regarding claims jurisdiction unassociated with beneficiary contracts, lacking regulatory authority or the ability to be reasonably implemented. And in so doing, the Blue plans attempting to implement this plan are running afoul of state and federal regulations; from non-adherence to HIPAA electronic standards to ignoring state assignment laws. Buckle up for a bumpy ride.