Blue Cross Blue Shield Association

If not already a familiar name, the medical billing and coding professional will surely encounter the Blue Cross Blue Shield Association at some point in their career, and will do well to know some basic details about the BCBSA.

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Formed by the merger of the Blue Cross Association and the Blue Shield Association in 1982, the BCBSA is the largest combined healthcare provider, offering healthcare services to nearly 100 million Americans every year. Headquartered in Chicago, there are 37 independently licensed companies that have signed together to become the BCBSA, which provide healthcare services throughout the 50 states. The BCBSA is also a significant provider of Medicare services; the program’s 2011 records show that the BCBSA was involved with 83 percent of Medicare Part A (hospital services) claims and 69 percent of Medicare Part B (physician and outpatient) claims nationwide.

Members, known as licensees, are independent of each other and in most instances operate non-competitively in separately designated regions or states throughout the country. The BCBSA’s largest member is Wellpoint, itself one of the three largest healthcare providers in the United States. Other significant members of the 37 total companies in the association include:

  • CareFirst
  • The Regence Group
  • Highmark
  • Health Care Service Corporation
  • Premera

Notable facts about the Blue Cross Blue Shield Association include:

  • 26 million member accounts
  • 92% of physicians and 96% of hospitals nationwide are in the association’s network
  • 97% of all billing and coding claims are paid within this network
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Medical Billing and Coding with the Blue Cross Blue Shield Association

This last statistical figure above should be striking for the medical billing and coding professional. 97 percent of all claims are paid within the BCBSA network. That means that the 37 licensee associations within the BCBSA are moving towards more of a standardized system of billing and coding that makes it easier to conduct transactions between each other. This could be interpreted in two different ways for billing and coding professionals.

On the one hand, a billing and coding professional would essentially need to be familiar only with the system(s) used within the BCBSA for billing and coding. Learning more of a standardized billing and coding system could prove to be simpler than dealing with many different systems of insurance companies and healthcare providers. This is especially true when processing claims from one regional or state provider.

On the other hand, because the BCBSA is the largest combined healthcare provider in the country, that means it provides on-average more services than a typical healthcare provider, and the resulting claims would also be more diverse. Therefore, despite having more of a streamlined system, coding the variety of medical services provided within this may ultimately result in a more complicated task.

Of course this is not to say that the process of medical billing and coding in a Blue Cross Blue Shield member company would be any different than the process in any other healthcare provider or insurance company. Medical billing and coding is usually organized in the most efficient and cost-effective way.

The billing and coding professional may also find that once working for a Blue Cross Blue Shield member company, it may be easier to transfer and apply for jobs within the association. This can be a significant advantage considering that the BCBSA operates in every state in the nation.