BCN Advantage℠ HMO-POS and BCN Advantage℠ HMO
Blue Care Network offers two types of Medicare Advantage plans: BCN Advantage HMO-POS and BCN Advantage HMO. All 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 2015, BCN Advantage is offered in 69 counties in Michigan. The BCN Advantage provider network is a subset of the BCN commercial provider network.
Use the links below to find out more about:
Prior Authorization and Step Therapy Guidelines
The BCN Advantage step therapy and prior authorization program manages the use of certain medications for which there may be equally effective, less costly alternatives available.
Prescriptions covered under Blue Care Network's drug riders are generally limited to a 31-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, Abuse and Compliance Training
The Centers for Medicare and Medicaid Services requires annual training to detect, prevent and correct fraud, waste and abuse. All providers and their employees, contractors, governing bodies and downstream entities who partner with Medicare Advantage organizations and prescription drug plans are required to take the training. New hires need to complete the training within 90 days of being hired and then annually.
Records of the training, including participant names, must be retained and available for inspection upon request for 10 years after the end date of the contract with Blue Cross Blue Shield of Michigan or Blue Care Network.
Follow these steps to complete compliance training.
2) Log in or create an account
3) Complete these training modules:
- Medicare Parts C and D general compliance training
- Combating Medicare Parts C and D Fraud, Waste and Abuse
4) Save a certificate for each module
*If you’re enrolled in Medicare Parts A or B, you’re not required to take additional fraud, waste and abuse training. However, you’re required to take the general compliance training and save the certificate for your records.
Providers who use their own training program must incorporate the content from the Medicare Parts C and D, fraud, waste and abuse training (PDF) and the Medicare Parts C and D general compliance training (PDF) modules into their training materials. Providers can't modify materials and need to keep a record of completion.
Regardless of the option you choose, certificates of completion must be kept on file for 10 years.
You can learn how to report fraud here.
Need Additional Information?
Log in to Provider Secured Services to find the following information:
- BCN Provider Manual chapter
- BCN Advantage formularies
- Notice of Medicare non-coverage for skilled nursing facilities and home health providers
For information about BCN Advantage, call BCN Provider Inquiry at 1-800-255-1690.