Care Guidelines for Medicare Advantage Members’ Availability and Access Standards

The CMS revised their guidelines for appointment availability for primary care, behavioral health, and substance-use disorder services.

Hospitals Must Provide Medicare Outpatient Observation Notice

As a reminder, hospitals and critical access hospitals are required to give the standardized Medicare Outpatient Observation Notice to our Blue Cross Medicare Advantage^SM members who are under outpatient observation for more than 24 hours. Instructions on how to complete the MOON are included.

Patients in the Qualified Medicare Beneficiary Program Should Not Be Billed

If you participate in Blue Cross Medicare Advantage plans, you may not bill our members enrolled in the Qualified Medicare Beneficiary program, which is a federal Medicare savings program. QMB beneficiaries are not responsible for Medicare Advantage cost-sharing or out-of-pocket costs. Review tips to avoid errant billing.

Prior Authorization Code Changes for Medicare Members, Effective Jan. 1, 2024

We’re changing our prior authorization requirements for Medicare members to reflect new, replaced or removed codes. A summary of changes is included.

Reminder: Prior Authorizations via eviCore^® for Blue Cross Group Medicare Advantage Plans

Blue Cross Group Medicare Advantage members may require prior authorization from eviCore for certain services. Services performed without proper authorization might not be reimbursed and you cannot seek reimbursement from members. Make sure to use Availity^® Essentials or your preferred vendor to check eligibility and benefits before rendering services.

Update Your Records: New Medicare Advantage Open Access PPO Members and ID Cards

As with all our members, it’s important to see their member ID card before all appointments, and to check eligibility and benefits. All Medicare Advantage members receive new ID cards Jan. 1. Newly enrolled members also have new ID numbers.