Imaging for Uncomplicated Low Back Pain

Effective January 1, 2024, there will be two BlueCard Local Plans in the five-county region of Southeastern Pennsylvania: Highmark Blue Shield and Independence Blue Cross. If you have a contract with Highmark as well as Independence Blue Cross, claims for BlueCard patients must be sent to the appropriate plan.

Highmark Blue Shield Claim Process

Even if you are not contracted with Highmark, all claims for Highmark Commercial members with dates of service January 1, 2024, or later, must be sent to Highmark Blue Shield. Claims for your patients covered by Highmark plans with dates of service prior to January 1, 2024, should still be sent to Independence Blue Cross.

Medicare Advantage

*Please note: BlueCard claims for Highmark Medicare Advantage members should still be sent to Independence Blue Cross. The Highmark Blue Shield Medicare Advantage network will not be effective in Southeastern PA until January 1, 2025.

Guidance on how to submit BlueCard claims to Highmark Blue Shield can be found in Chapter 2, Unit 6 of the Highmark Provider Manual.

Independence Blue Cross Claim Process

All claims for Independence Blue Cross patients for dates of service January 1, 2024, or later should be sent exclusively to Independence Blue Cross, even if you are not a contracted provider with them.

Other Out-of-Area Claims

BlueCard member claims — for any other Blue Plan that you are not contracted with — can be sent to either Highmark Blue Shield or Independence Blue Cross for processing; however, you will only be able to submit these claims to one of these plans. If you submit a claim to one of the two local Southeastern PA Blue plans, you will not be able to resubmit to the other. (Example: Claims sent to Highmark Blue Shield that are denied/rejected may not be sent to Independence Blue Cross for reprocessing).

Claims originally submitted to Highmark Blue Shield must be completed with Highmark and claims originally submitted to Independence Blue Cross must be completed with Independence Blue Cross, including any follow-up actions on the claims.

For more information on filing BlueCard claims with Highmark, please visit the BlueCard Information Center on the Provider Resource Center.