About Blue Cross Blue Shield
Blue Cross Blue Shield is a federation of 35 independent health insurance companies operating under the BCBS brand. Collectively, BCBS plans cover over 100 million Americans — more than any single commercial insurer — and operate in all 50 states. Because each BCBS plan is independently operated, reimbursement rates, authorization requirements, and billing processes vary significantly by state.
How fast does Blue Cross Blue Shield pay?
Reimbursement timelines vary by BCBS state plan. Most BCBS plans reimburse clean claims within 30 to 45 days. Some state plans, particularly those with higher administrative complexity, can extend to 60 days. FEP (Federal Employee Program) claims typically process within 30 days.
Common denial and billing issues.
- Claim submitted to wrong BCBS state plan (out-of-state member)
- BlueCard program routing errors for out-of-state members
- Federal Employee Program (FEP) claims submitted to wrong payer ID
- National account vs. local plan billing discrepancies
- Authorization obtained from wrong BCBS entity
- Eligibility verification errors due to multiple BCBS plan IDs
Prior authorization requirements.
Authorization requirements vary by BCBS state plan. Most plans require authorization for inpatient services, specialty procedures, and home health. National accounts may have centralized authorization through AIM Specialty Health or eviCore. Always verify authorization requirements with the specific state plan.
How Copay works with Blue Cross Blue Shield.
BCBS claims are evaluated by Copay based on the specific state plan and contract terms applicable to your practice. Copay's ENR model maintains separate reimbursement performance data for each BCBS affiliate, ensuring accurate purchase valuations that reflect your actual BCBS contract rates.
Stop waiting on Blue Cross Blue Shield.
Eligible claims are purchased and funded the next business day.