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August 2019

Reminder: Providing services to patients in an out-of-state MA PPO plan

Each year, we like to remind our health care providers about Medicare Advantage PPO network sharing for Blue Cross Blue Shield plans. Network sharing allows patients to see any Medicare Advantage PPO provider across the country and obtain in-network benefits.

If you’re a Blue Cross Blue Shield of Michigan-contracted MA PPO provider and see a Medicare Advantage PPO member from another Blue plan, they’ll have the same access to care as a Blue Cross Blue Shield of Michigan member. You’ll also receive reimbursement according to your agreement with Blue Cross.

If you’re not contracted with Blue Cross Blue Shield of Michigan for our MA PPO plan and you provide services for any Blue Medicare Advantage member, you’ll receive the Medicare-allowed amount for covered services. (Note: For urgent or emergency care, you’ll be reimbursed at the member’s in-network benefit level. Other services will be reimbursed at the out-of-network benefit level.)

Here are answers to a few frequently asked questions:

How will I know that a patient is covered under the MA PPO network sharing program?

You’ll see a Blue Cross Blue Shield ID card with this logo on it:

MA PPO Medicare Advantage logo

How do I verify benefits and eligibility?

Check web-DENIS or call BlueCard Eligibility at 1-800-676-BLUE (2583) and provide the member’s prefix that’s located on the ID card.

How do I get more information?
For more information, access the Medicare Plus Blue PPO manual by clicking here.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.