New Feature Launch: Blue Card Eligibility Identification

We’re excited to announce the launch of Blue Card Eligibility Identification - a new capability designed to improve network status accuracy and reduce ambiguity when working with BCBS plans.

What We’ve Built

When a patient presents with a Blue Cross Blue Shield (BCBS) policy, determining the correct network and payer pathway can be complex - especially for Blue Card members, where the member’s home plan differs from the provider’s local BCBS plan.

With this new feature, we now can:

• Identify whether a patient’s BCBS policy is Blue Card eligible
• Use this to improve network status identification & member obligation accuracy
• Provide greater clarity into how the claim should be routed and adjudicated

This logic is based directly on the member’s policy details, enabling us to distinguish between local and out-of-area BCBS coverage more reliably.

Why This Matters

Blue Card misclassification is one of the most common causes of:

• Incorrect network determinations
• Claim routing issues
• Unexpected reimbursement discrepancies
• Increased back-and-forth for billing teams

By programmatically identifying Blue Card eligibility upfront, we help providers:

• Reduce manual verification work
• Improve confidence in in-network vs out-of-network determinations
• Decrease downstream claim errors
• Deliver clearer benefit explanations to patients

How to Access:

If you are not set up with Nirvana, reach out to our team via the get started button below. If you are an active Nirvana Customer, see directions below:

In both One Verify and our estimate response, you will now see a bluecard_eligible field that returns {True, False}