Blue Medicare PPOSM Claims

Availity

Blue Medicare PPO claims should be submitted as follows:

  • Providers may use their own clearinghouses for claims submission. However, the Availity Health Information Network is the front door for electronic claims submission into the Blue Medicare PPO claims processing system.
  • Blue Medicare PPO Electronic Payor ID number - NMPPO
  • For information on electronic filing of Blue Medicare PPO claims, contact the Availity customer service center at 1-800-AVAILITY (1-800-282-4548).
  • For more information on additional claims services, you may also go to the Availity Web site.
  • Blue Medicare PPO claims must be submitted within 180 days of the date of service. Claims that are not submitted within 180 days from the date of service are not eligible for reimbursement. Blue Medicare PPO providers may not seek payment from the member for claims submitted after the 180-day filing deadline, except for applicable deductibles, copayments, and coinsurance amounts.
  • Blue Medicare PPO paper claims must be submitted on the Standard CMS-1500 (Physician/Professional Provider) or CMS-1450 (UB04 - Facility) claim form to:

Blue Medicare PPO
P.O. Box 3567
Scranton, PA 18505

  • Blue Medicare PPO claims (electronic & paper) must be filed with the Member's complete ID number - exactly as shown on the Member's ID card, including the 3-digit alpha prefix - YID.

Blue Medicare PPO claims containing adequate information and submitted in accordance with these guidelines will be paid within 30 days.

Duplicate Blue Medicare PPO claims may not be submitted prior to the applicable 30-day claims payment period.

Claims Pricing

Pricing of claims for Blue Medicare PPO is in accordance with your contract with us. We use CMS pricing which you can review at CMS pricing site.

The CMS Correct Coding Initiative (CCI) is also used to combine codes that CMS has determined should be combined for billing and payment. The CCI information is on the CMS Web site and this link for your convenience.

Claims Disputes

Blue Medicare PPO participating facilities may dispute a claims payment decision by requesting a claim review. If you have questions regarding a claims dispute, please contact the Blue Medicare PPO Provider Customer Service Department at 1-866-706-7745.