Blue Cross Medicare AdvantageSM Plans



Print

Medicare Advantage plans offer all the coverage as Original Medicare — plus benefits not covered by Medicare or most Medicare Supplement insurance plans, including built-in prescription drug coverage and extra health and wellness options. Blue Cross and Blue Shield of New Mexico (BCBSNM) offers both individual and group Medicare Advantage plans.

 

Individual Plans

  • The Blue Cross Medicare Advantage HMO/HMO SNP plans offer health coverage to members who reside in Bernalillo, Dona Ana, Sandoval, Santa Fe, Torrance and Valencia counties.
  • The Blue Cross Medicare Advantage HMO/HMO POS plans offer health coverage to members who reside in Bernalillo, Sandoval, Santa Fe, Torrance and Valencia counties.
  • The Blue Cross Medicare Advantage (PPO) plan offers health coverage to members who reside in Bernalillo, Sandoval, Santa Fe, Torrance and Valencia counties.

Group Plans

Our retiree group Medicare plans are:

  • Blue Cross Group Medicare Advantage (HMO)SM
  • Blue Cross Group Medicare Advantage (PPO)SM
  • Blue Cross Group Medicare Advantage Open Access (PPO)SM
  • Blue Cross Group MedicareRx (PDP)SM

Our strong brand recognition and our historical relationship with Medicare makes BCBSNM an excellent choice for Medicare-eligible individuals. We maintain and monitor a network of participating providers including physicians, hospitals, skilled nursing facilities, ancillary providers, and other health care providers through which members obtain covered services.

 

Out-of-network Note: If you see Medicare members or accept Medicare assignment and are willing to bill BCBSNM, you may treat Blue Cross Group Medicare Advantage Open Access (PPO) members. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. In-network providers will be paid at their contracted rate. For eligibility, prior authorization or claims inquiries, call 877-299-1008.




Participating physicians, professional providers, and facility providers must submit claims to Blue Cross Medicare Advantage within 180 days of the date of service, using the standard CMS-1500 or UB-04 claim form, or electronically. Services billed beyond 180 days from the date of service are not eligible for reimbursement.


To join our Blue Cross Medicare Advantage network, follow the process for Network Participation.



All providers who contract with BCBSNM to provide Medicare Advantage services are expected to abide by the Centers for Medicare & Medicaid Services (CMS) rules for marketing when it involves BCBSNM or Blue Cross Medicare Advantage products or benefits.


View the guidelines that are applicable to providers in the Provider Medicare Marketing Guidelines Excerpt 


 

To view the following forms, go to the Attachments section of the Blue Cross Medicare Advantage section of the Blues Provider Reference Manual .

  • New Mexico Optional Advance Health Care Directive Form
  • Notice of Medicare Non-Coverage

Blue Cross Medicare Advantage plans are HMO, HMO-POS and PPO plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.