BCN Advantage HMO-POS℠ and BCN Advantage HMO℠

Blue Care Network offers two Medicare Advantage plans: BCN Advantage HMO-POS and BCN Advantage HMO. BCN Advantage℠ plans combine the benefits of original Medicare Parts A and B with additional coverage to create health care plans offering Medicare coverage and much more.

For 2013, BCN Advantage is offered in 42 counties in Michigan. The BCN Advantage provider network is a subset of the BCN commercial provider network.

To learn more about BCN Advantage, select from the options below, which take you to information available on Blue Care Network's site:

• Network
• Service area
• Benefits information
• General information for BCN Advantage members

Provider Resources

Use the links below to find out more about:

• BCN Advantage formularies
• Requesting prescription drug coverage

Prior Authorization and Step Therapy Guidelines

The BCN Advantage step therapy and prior authorization program manages the use of certain medications for which there are equally effective, less costly alternatives available.

• Review the Prior Authorization and Step Therapy Criteria (PDF)

Quantity Limits

Prescriptions covered under Blue Care Network's drug riders are generally limited to a 34-day supply when dispensed by a retail pharmacy and 90 days through our mail order service or preferred retail pharmacy. Blue Care Network has established quantity limits for certain medications based either on package size or to promote appropriate prescribing of drugs intended for once daily dosing. These are noted in the comprehensive formulary documents.

Fraud, Waste and Abuse

The Centers for Medicare and Medicaid Services requires all entities and their employees who partner with Medicare Advantage organizations and prescription drug plans to complete annual training to detect, prevent, and correct fraud, waste, and abuse. Records of that training, including participant names, must be retained and available for inspection upon request. To assist our Medicare partners in meeting this requirement, Blue Cross Blue Shield of Michigan and Blue Care Network have developed a slide presentation available below for your use. Instructions on how to report fraud are also included below.

• Fraud, waste and abuse training (PDF)
• Report fraud
  

Need Additional Information?

Additional BCN Advantage information is available on web-DENIS, within our secure provider portal including:

• BCN Provider Manual chapter
• BCN Advantage formularies
• Notice of Medicare non-coverage for skilled nursing facilities and home health providers

Go directly to BCN Advantage information on web-DENIS (log in with your user ID and password).

Or, gain access by clicking on the login button at the top of this page and choosing Provider.

1. Log in using your web-DENIS user ID and password.
2. Select BCN Provider Publications and Resources.
3. Under Products, select Government Programs to browse available BCN Advantage documents.

For more information about BCN Advantage, call BCN Provider Inquiry at 1-800-255-1690.