Skip Ribbon Commands
Skip to main content
Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Reminder: Medicare Advantage PPO Network Sharing billing procedures

May 31, 2013

The Blue Cross and Blue Shield Association (BCBSA), an association of independent Blue Cross and Blue Shield plans, created the national Medicare Advantage PPO Network Sharing program. As a participant in this program, IBC accepts Medicare Advantage PPO enrollees from other Blue Plans as our local members when they travel or reside in our five-county Philadelphia service area. This program is similar to the BlueCard[]?[] Program for commercial Blue Cross[]?[] and Blue Shield[]?[] PPO Plans.[
]As a participating provider, you are expected to provide services to these Medicare Advantage PPO plan enrollees who present to you for treatment. ID cards for Blue Cross and Blue Shield Medicare Advantage PPO enrollees contain an "MA" in the suitcase logo.These enrollees have been instructed to provide their Blue Cross and Blue Shield Medicare Advantage PPO ID card — not their standard Medicare ID card — when presenting to your office/facility for services.[

]Submit claims to IBC[

]Participating providers should submit all professional, facility, and ancillary claims for covered services for Blue Cross and Blue Shield Medicare Advantage PPO enrollees to IBC. You will be paid the contracted rates for covered services for these members.Note: As previously communicated, as of January 1, 2011, professional and ancillary claims for Blue Cross Blue Shield Medicare Advantage PPO members must be submitted to IBC, not to Highmark Blue Shield. However, you should continue to submit commercial BlueCard claims to Highmark Blue Shield, as this process has not changed.[

]Submission guidelines[

]All claims for Blue Cross and Blue Shield Medicare Advantage PPO enrollees that are submitted to IBC as the HostPlan must be completed in accordance with Personal Choice 65SM PPO guidelines. As the Host Plan, IBC will apply the following to claims for Blue Cross Blue Shield Medicare Advantage PPO enrollees:Centers for Medicare & Medicaid Services' National Coverage Determinations (NCD)Local Coverage Determinations (LCD)select IBC Reimbursement PoliciesHome Plan medical policy may also be applied.Visit our []medical policy website[] for more detailed information about NCDs and LCDs or to view a list of the applicable IBC Reimbursement Policy documents. Be sure to visit the site often, as it is updated frequently.If you have any questions about Blue Cross Blue Shield Medicare Advantage PPO, please contact your Network Coordinator.

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.