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Arkansas Blue Cross Blue Shield to administer Walmart benefits


Effective January 1, 2010 Walmart associates nationwide will be covered by Arkansas Blue Cross Blue Shield via its TPA subsidiary Blue Advantage Administrators. Additionally, Walmart has chosen New Directions as their behavioral health vendor for the PPO products.

New ID cards will reflect a WMW prefix. A large volume of Walmart associates are impacted by this change. Therefore, it is important to ask for a current copy of the patients ID card during each visit to ensure accurate filing of claims for dates of service beginning January 1, 2010.

Some important basics to assist your practice when rendering services for Walmart associates and their family members:

  • Providers will continue to contact Blue Cross and Blue Shield of North Carolina (BCBSNC) for inquiries regarding eligibility, benefits, pre-certification requirements and claim submission
  • Eligibility, benefits and pre-certification requirements will be available through Blue esm or by calling 1-800-676-BLUE (2583)
  • New ID cards will be issued reflecting a new alpha prefix. The alpha prefix will be "WMW"
  • Claims are to be filed to the local Plan (BCBSNC) using the exact ID card number, inclusive of the alpha prefix. Do not add, omit or alter any characters from the member ID number
  • Providers will be reimbursed at their contracted rate
  • Claims must be filed under the ID card prefix that is in effect at the time the service was rendered
  • Illinois and Alabama Blue Cross will handle payment of run-out of claims for their current Walmart members through 2010

Some important basics regarding new mental health benefits:

  • Providers should request a copy of the member's new insurance card which contains contact information and new ID number information
  • New Directions is providing managed behavioral healthcare for the PPO product only. The HMO product will continue as in the past
  • Beginning the last week of December, providers may check eligibility and benefits for members they will see on or after January 1, 2010 by calling 1-877-709-6822. For dates of service after February 1, 2010 it is recommended providers apply online at www.ndbh.com for Provider WebPass - an online tool allowing participating providers to check eligibility, benefits and submit outpatient treatment requests when needed
  • New Directions toll free number will appear on the back of Walmart associates' health cards. However, beginning February 2010 the preferred method of provider inquiries is to visit New Directions on the Web at www.ndbh.com.
  • Preauthorization is required for payment of behavioral health services rendered in facilities for both ambulatory and inpatient services
  • Outpatient office visits will require preauthorization upon the 9th visit per benefit year
  • Medication management sessions for outpatient office visits will not require authorizations
  • Claims are submitted to BCBSNC
  • Providers will be reimbursed at their contracted rate
  • Local PPO networks will continue to be in-network for Walmart associates

Questions regarding these changes should be directed to your local Network Management representative.