Providers who contract with a Blue Cross Blue Shield (BCBS) Medicare Advantage PPO plan can now freely treat patients with plans from other service areas.
On Jan. 1, 2010, most BCBS Medicare Advantage PPO plans began participating in reciprocal network sharing—meaning that patients with these plans can obtain in-network benefits when traveling or living outside of their service area if they see a BCBS Medicare Advantage PPO contracted provider.
Physicians will either be reimbursed at their plan’s rate or the Medicare allowed amount if the patient’s plan does not participate in network sharing.
Out-of-area patients whose plans participate in network sharing will be identified by a small suitcase around the letters “MA” on their BCBS member ID card. Patients will have in-network cost-sharing responsibilities, so you may collect co-pays. The claim should be submitted to your Medicare Advantage PPO plan as usual.
If your practice is closed to new local Medicare Advantage PPO patients, you do not have to provide services to out-of-area patients.