If You Don't Participate with Medicare

Providers must participate with Medicare in order to join the Medicare Advantage PPO network, unless the provider's specialty is exempt from participation in Medicare by CMS.

Information about network participation and affiliation is available in the Medicare Plus Blue PPO Manual (PDF) and Blue Cross® Medicare Private Fee for Service manual (PDF). If you're not a Blue Cross® Medicare PFFS provider but are treating PFFS patients, you can learn more about the plan in the PFFS Terms and Conditions (PDF).

Limiting charge

For providers who have not contracted with Medicare or BCBSM's Medicare Advantage PPO network, the limiting charge applies to certain provider types for specific billing situations.

More information about Medicare's limiting charge can be accessed in Chapter 4 of the Medicare Managed Care Manual (PDF).