Northwood to cover DME/P&O utilization management and claims for Medicare Plus Blue PPO starting in May

Northwood Inc., an independent company that manages the durable medical equipment, prosthetics, orthotics and medical supply provider network for Medicare Plus Blue^SM PPO members, will also handle authorizations, utilization management and claims processing, starting in May.

Beginning with dates of service on or after May 1, 2019, Northwood-contracted providers will be required to obtain authorizations and submit their claims to Northwood. Continue to submit out-of-network claims for Medicare Plus Blue PPO members directly to Blue Cross. For out-of-network claims, use the Medicare fee schedule, which may involve a higher level of cost-sharing for members.

All Medicare Plus Blue plans include DME/P&O and medical supplies, along with some inhalation medications used with nebulizers that are covered under original Medicare.

In the next few months, Northwood will send provider education communication materials to its contracted providers with details on the transition and information about handling authorizations, utilization management and claims for Medicare Plus Blue members.

If you have any questions, contact Northwood Provider Relations at provideraffairs@northwoodinc.com or 1-800-447-9599.