Blue Medicare PPO is a Medicare Advantage product offered by HCSC Insurance Services Company (HISC), a wholly owned subsidiary of Health Care Service Corporation (HCSC). It is a preferred provider organization (PPO) plan offered to Medicare Part A and Part B Members in all counties in the state of New Mexico.
Blue Medicare PPO maintains and monitors a network of Participating Providers including physicians/professional providers, hospitals, skilled nursing facilities, ancillary providers and other health care providers for members to obtain covered services. Although selection of a Primary Care Physician (PCP) is not required, members are encouraged to have a participating physician/specialist provider coordinate their care with participating specialty care physicians/professional providers.
To participate in the Blue Medicare PPO provider network:
- Providers must be participating with Blue Cross and Blue Shield of New Mexico (BCBSNM)
- Professional providers must have privileges at one of the Blue Medicare PPO participating hospitals (unless inpatient admissions are uncommon or not required for the physician's/professional provider's specialty)
- Providers must have a valid National Provider Identifier (NPI)
- Providers must sign a Medicare Advantage Amendment to their BCBSNM Medical Services Entity Agreement
- Providers cannot have opted out of Medicare or have any sanctions or reprimands by any licensing authority of review organizations. Blue Medicare PPO participating providers cannot be named on the Office of the Inspector General (OIG) or Government Services Administration (GSA) lists which identify providers found guilty of fraudulent billing, misrepresentation of credentials, etc. Blue Medicare PPO participating providers cannot be sanctioned by the Office of Personnel management or be prohibited from participation in the Federal Employees Health Benefit Program (FEHBP)
