Group Retiree Medicare Advantage has two plans PPO and National Access Plus. These plans are offered through Anthem BCBS (Anthem).
Below please find the FAQs regarding these 2 plans:
What does Anthem BCBS Nevada Group Retiree Medicare Advantage PPO and National Access Plus Plans may include?
Group Retiree Medicare Advantage memberships may include the National Access Plus benefit, which allows retirees to receive services from any provider, as long as the provider is eligible to receive payments from Medicare and accepts the member’s PPO plan.
Extra services that traditional Medicare does not cover?
The PPO plans also offer benefits that original Medicare doesn’t cover, including an annual routine physical exam, hearing, vision, chiropractic care, acupuncture, LiveHealth Online* and SilverSneakers®.*
Anthem Medicare Preferred (PPO):
Sample Mediblue Freedom (PPO) Plan cards:
What are the alpha prefixes for Group Retiree Medicare Advantage PPO members?
Do I need to participate in the Medicare Advantage PPO network to see members with the
National Access Plus benefit?
No contract is required. You can still see your current patients and new patients who have one of the following Medicare Advantage PPO plans:
Anthem Medicare Preferred (PPO)
Empire MediBlue Freedom (PPO)
What is the payment rate for out-of-network providers who treat Medicare Advantage PPO
members with the National Access Plus benefit? Out-of-network providers are paid Medicare allowable rates for covered services, less the member’s copay, coinsurance, and/or deductible.
Does the member have a higher copay if they see me as an out-of-network provider?The National Access Plus benefit allows retirees to receive services from any provider, as long as the provider is eligible to receive payments from Medicare. The member’s copay or coinsurance percentage will be the same whether his/her provider is in- or out-of-network. Whether local or nationwide, doctor or hospital, in- or out-of-network — the member’s cost share doesn’t change. If the member is in one of our PPO plans but the plan does not include the National Access Plus benefit, the member could have a higher copay. Please check member eligibility and benefits to verify the cost share.
How does a provider file claims for Medicare Advantage PPO members with or without the National Access Plus benefit?
Providers may submit claims electronically using the electronic payer ID for the Anthem plan in their state or submit a UB-04 or CMS-1500 form to the Anthem plan in their state. Claims should not be filed with original Medicare. You can file a claim:
- Online at availity.com.
- Via mail by sending it to the medical claims and inquiries filing address on the back of the member’s ID
card.
I do not participate in the Medicare Advantage PPO network. I am waiting to hear if a PA
request is approved. Should I ask the member to reschedule or postpone the appointment
until I have confirmation that my PA request is approved?
Non-contracted providers are not required to request PA, but we recommend that you do so to ensure we can assist you with any questions or issues. Anthem will work with providers to approve PAs so members do not postpone appointments.
Are referrals required?
No, members are not required to obtain a referral before they see a provider.
For a complete list of FAQs, including Utilization Management/Prior Authorization process information, please click here for a pdf attachment.
Find this blog informative? Then check out my latest blogs below:
- UHC Minnesota Community Plan: non-emergency transport
- EmblemHealth Commercial Plans: site of care change – adding 170 new injectable and infusion meds to the list
- Aetna: Reimbursement for evaluations with G2082 and G2083 codes…
- Cigna to add more codes to their Virtual Vare Reimbursement Policy and make them permanent, however…
- HealthFirst: new vision insurance payer
KR2 Medical Billing 