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2023-098B
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Last modified
3/18/2024 12:03:39 PM
Creation date
3/18/2024 11:53:00 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/16/2023
Control Number
2023-098B
Agenda Item Number
12.D.2.
Entity Name
Blue Cross and Blue Shield
Subject
Shield Transition Health Plan Administrative Services from
Blue Cross Shield of Florida Inc.(Florida Blue)
to Blue Cross Blue Shield National Alliance effective 10/01/2023 thru 9/30/2026
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Service Center to initiate claims processing. However, if the member paid in full <br />at the time of service, the member must submit a claim to obtain reimbursement <br />for covered healthcare services. Members must contact BCBSF and/or its <br />Designated Agent to obtain precertification for non -emergency inpatient services. <br />• Outpatient Services <br />Physicians, urgent care centers and other outpatient providers located outside the <br />B1ueCard service area will typically require members to pay in full at the time of <br />service. Members must submit a claim to obtain reimbursement for covered <br />healthcare services. <br />• Submitting a Blue Cross Blue Shield Global® Core Claim <br />When members pay for covered healthcare services outside the BlueCard service <br />area, they must submit a claim to obtain reimbursement. For institutional and <br />professional claims, members should complete a Blue Cross Blue Shield Global® <br />Core International claim form and send the claim form with the provider's <br />itemized bill(s) to the Blue Cross Blue Shield Global® Core Service Center <br />address on the form to initiate claims processing. The claim form is available from <br />BCBSF and/or its Designated Agent, the Blue Cross Blue Shield Global® Core <br />Service Center, or online at www.bluecardworldwide.com. If members need <br />assistance with their claim submissions, they should call the Blue Cross Blue <br />Shield Global® Core Service Center at 1.800.810.BLUE (2583) or call collect at <br />1.804.673.1177, 24 hours a day, seven days a week. <br />2. Blue Cross Blue Shield Global® Core -Related Fees <br />Employer understands and agrees to reimburse BCBSF and/or its Designated Agent <br />for certain fees and compensation which we are obligated under applicable Inter -Plan <br />Arrangement requirements to pay to the Host Blues, to the Association and/or to <br />vendors of Inter -Plan Arrangement related services. The specific fees and <br />compensation that are charged to Employer under the Blue Cross Blue Shield Global® <br />Core are set forth in this Exhibit B, if applicable. Fees and compensation under <br />applicable Inter -Plan Arrangements may be revised from time to time. <br />36 <br />
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