• What is Blue Medicare
PPO?
• Do I need to be a
participating provider in Medicare to be included in the
Blue Medicare PPO network?
• How is this program being
marketed?
• Will there be any office visit
co-pays?
• If I am already participating in
the BCBSNM PPO network, what else do I need to do to be
included in the Blue Medicare PPO network?
• Are there other special
requirements to participate in Blue Medicare PPO?
• Does the ID card for this product
have BCBSNM and the Blue Medicare PPO logos?
• Are referrals required? Do
services require prior authorization?
• Does BCBSNM use their current
claims and membership system for administering the Blue
Medicare PPO plan?
• If I am already
participating in the BCBSNM PPO network, is any additional
credentialing required?
• Who can I call for additional
information about this program?
Blue Medicare PPO is a Medicare Advantage plan offered by HCSC Insurance Services Company (HISC), an independent licensee of the Blue Cross and Blue Shield Association under contract with the Centers for Medicare and Medicaid Services (CMS). Our members receive their Medicare Part A and Part B benefits through Blue Medicare PPO. In addition, Blue Medicare PPO provides Part D drug coverage to our members.
Note: CMS under the Medicare Modernization Act of 2003 has changed the name from Medicare + Choice plan to Medicare Advantage (MA).
Yes, you need to be participating in the traditional Medicare program if you want to participate in the Blue Medicare PPO network.
How is this program being marketed?
This program will be marketed directly to eligible Medicare beneficiaries who reside in all counties in New Mexico.
Will there be any office visit co-pays?
Yes, the Blue Medicare PPO benefit plan requires a member to pay a co-pay amount for each office visit, Emergency Room visit or urgent care visit. Similar to other BCBSNM products, a member enrolled in the Blue Medicare PPO plan has an identification card with the Blue Medicare PPO logo identifying the type of plan, benefit plan features including co-pays, phone numbers to call for provider customer service, the number for preauthorization for certain services, and other pertinent information.
Sign and date a Medicare Advantage Amendment and return it to the address listed below.
Return Amendment to:
Blue Cross and Blue Shield of New Mexico
ATTN: Network Services
P.O. Box 27630
Albuquerque, NM 87125-7630
Are there other special requirements to participate in Blue Medicare PPO?
To participate in the Blue Medicare PPO, facilities and other ancillary providers or physicians/professional providers:
- Must be a participating facility or ancillary provider or physician/professional provider with BCBSNM
- Must sign a Medicare Advantage Amendment to their BCBSNM Medical Services Entity Agreement
- Cannot have opted-out of Medicare or have any sanctions or reprimands by any licensing authority or review organizations. Blue Medicare PPO participating facilities/ancillary providers or providers/professional providers cannot be named on the Office of the Inspector General (OIG) or Government Services Administration (GSA) lists which identify facilities and physician/professional providers found guilty of fraudulent billing, misrepresentation of credentials, etc. Blue Medicare PPO participating facilities/ancillary providers or physicians/professional providers cannot be sanctioned by the Office of Personnel Management or be prohibited from participation in the Federal Employees Health Benefit Program (FEHBP).
Does the ID card for this product have BCBSNM and the Blue Medicare PPO logos?
Yes both logos are on the card.
Are referrals required? Do services require prior authorization?
Referrals are not required. Certain services will require prior authorization. A telephone number is located on the back of the identification card. View the complete list of services that require preauthorization.
BCBSNM's customer service representatives are available to Various functions, including but not limited to marketing, claims processing and membership, are outsourced. However, you can continue to use the Availity Health Information Network to file your claims.
If I am already participating in the BCBSNM PPO network, is any additional credentialing required?
Additional credentialing will not be required for those physicians who are already contracted as a BCBSNM participating provider.
Who can I call for additional information about this program?
Please contact your Network Services Government Programs Contractor, Cathie Rowland-Robert, at 505-816-2132, for questions specific to this product. For general questions regarding your participation with BCBSNM, contact your Network Services Provider Representative, at 505-837-8800, or 1-800-567-8540
