Medicare Advantage Private Fee-For-Service plan to offer members an additional choice

To provide more choices for our Medicare-eligible members, we’re developing a Medicare Advantage Private Fee-For-Service plan. Eligible members will be offered the MA PFFS plan during the 2016 annual enrollment period, with coverage starting Jan. 1, 2017.

We’re building the Centers for Medicare & Medicaid Services-required PFFS network for 2017 using our existing statewide MA PPO network of providers. Your participation in the network is essential to ensuring that your patients have greater product choice, along with the ability to retain their current providers. We’ve changed the MA PPO Provider Contract to include this new product.

If you choose to participate in the MA PFFS plan, you don’t need to do anything. If you don’t want to participate in the plan, you’ll need to opt out of the MA PFFS network by Feb. 11, 2016, as the new contract will take effect on Feb. 12, 2016. However, we believe that you‘ll find this product easy to work with and also will give your patients who are transitioning to Medicare an additional option to consider.

The new contract is available for review on bcbsm.com/providers, along with the form to opt out. Here are the steps to follow:

• From the Provider Enrollment section of bcbsm.com/providers, follow the prompts.
• On the Forms and Documents page, click on the light blue box to expand the section on BCBSM agreements and signature documents.
• The provider who agrees to the agreement and information in the attachment must complete the signature document.
• Follow the directions on the document to submit the form to Blue Cross.

Opting out of the MA PFFS plan will not affect your MA PPO affiliation.

Here are some key facts about the new plan:

• Reimbursement will be the same as it is with your MA PPO Agreement.
• It pays on a fee-for-service basis.
• There are no preauthorization requirements.
• There is minimal member cost-sharing for services covered under the plan. Most services will have no copays or coinsurance.
• There is no drug component

If you have questions, contact your provider consultant.