Blue Cross Medicare Advantage PPOSM Group Retiree

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Blue Cross Medicare Advantage PPO^SM Group Retiree

May 15, 2018

Blue Cross Medicare Advantage PPO^SM is offering a retiree plan for employer groups as of 1/1/2018 that allows members to see Blue Cross Medicare Advantage PPO contracted providers as well as providers that do not contract with the Blue Cross Medicare Advantage PPO but who accept Medicare Assignment. Membership for this product can be nationwide for employer groups that offer the Blue Cross Medicare Advantage PPO to retirees. These members can be identified by alpha prefix ZZT on their ID Cards.

Members will have access to a national Blue Cross Medicare Advantage PPO network of participating providers. A provider that accepts Medicare assignment can be non-participating in the national Blue Cross Medicare Advantage PPO network. Note: To become a participating provider within the Blue Cross Medicare Advantage PPO network, a provider must accept Medicare assignment.

Members can see Blue Cross Medicare Advantage PPO network participating providers and/or providers who accept Medicare assignment. A provider that accepts Medicare assignment can be non-participating in the national Blue Cross Medicare Advantage PPO network. In this case, we would reimburse these providers using the traditional Medicare allowable on the Medicare fee schedule. Facility providers who don’t accept assignment would need a single case agreement to establish an allowance. For facility providers the Medicare provider number is used to determine allowances and if a provider does not accept assignment they usually do not have a Medicare provider number.

As a reminder during each office visit, your office staff should:

Ask for the member's ID card (Alpha Prefix ZZT). Copy both sides of the member's ID card and keep the copy with the patient’s file.
Determine if the member is covered by another health plan to record information for coordination of benefits purposes.
Refer to the member’s ID card for the appropriate telephone number to check eligibility in the Blue Cross Medicare Advantage PPO, deductibles, coinsurance amounts, copayments, and other benefit information.

If you are unsure if the member is enrolled in a Blue Cross Medicare Advantage PPO plan, please call the number on the member’s card for confirmation.

Please note that verification of eligibility and benefits information, and/or the fact that any pre-service review has been conducted, is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered.