ID Cards

Once a plan member enrolls with a health plan, they are provided with an Identification (ID) card. This card is critical to medical providers and billers as this small card provides tons of information about the plan.

Appearance

All identification cards are about the same size as a credit card but they are unique to the health carrier that issued them. They all provide the health carrier’s name, and maybe the logo, and they all have distinctive card colors and formats. This way you can tell, at a glance, what health carrier the patient belongs too.

The Front of the ID Card

Every ID card issued by all of the different health carriers may be similar in look but the information provided could be totally different. Generally, on the front of the card you will find the group number, member name and ID number and on some ID cards you will also see the names of all dependents that are eligible under the plan. 

You may also find the: 

  • Effective date of coverage
  • Type of plan: PPO, HMO, FFS, POS etc.
  • Copay amounts by type of service i.e. Office, Preventative, Specialty, Urgent care etc.
  • Name and phone number of the Primary Care Physician
  • Prescription numbers
  • Deductibles
  • Coinsurance amounts
  • Dental and Vision information 

The Back of the ID Card

Again, the information provided on the ID card could totally differ by health carrier but generally the back of the card is usually all about contact information, including:

  • Phone numbers of member services, provider services, utilization review, the 24 helpline, etc.
  • Insurance carrier name, address and phone numbers.
  • Mailing address on where to bill claims.
  • Numbers to call if you are admitted to a hospital or have a medical emergency.

Just FYI

The identification card is presented to the provider when a patient comes in the office, the provider should keep a copy of the front and the back of the ID card. 

An identification card is not a guarantee of coverage or eligibility – the ID card is never confiscated when coverage ends so it is possible that a patient could give you a card and no longer have health insurance coverage.

Some health carriers will change the member ID number yet all other aspects of the card remain the same. For this reason, some patients will not swap out the old card they are carrying for the new card. Using the old ID card could result in coverage and eligibility issues and claim denials. Calling the carrier to verify coverage is key.

The way a name is entered on the ID card should be the same way a claim is entered in the billing system and the same way the claim is billed to the health carrier. The name on the card is the name the health carrier has on file for this patient.

For example

The patient's name is Elizabeth Smith, yet the patient prefers to go by Beth Smith. Because the billed claim will differ from the name in the health carrier’s system, they may reject the claim.

Finally, although the ID card provides some great information, it is not a substitute for calling the health carrier directly to confirm benefits and eligibility. The ID card is only part of what is needed to make sure that the visit will result in a paid claim.


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