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Medicare Advantage PPO Network Sharing

February 14, 2011

What is BlueCross Medicare Advantage PPO Network Sharing?

Network Sharing allows MA PPO members from all MA PPO Blue Plans to get in-network benefits when traveling or living in the service areas of other MA PPO Blue Plans as long as the member sees a contracted Medicare Advantage PPO provider. There are currently 36 states and one territory in the network for MA PPO Network Sharing.

What does BlueCross Medicare Advantage PPO Network Sharing mean to me?

If you are a contracted MA PPO provider with BlueCross BlueShield of South Carolina and you see MA PPO members from other Blue Plans, these members have the same contractual access to care. You will be reimbursed in accordance with your BlueCross BlueShield of South Carolina contract rate. These members will receive in-network benefits in accordance with their member contracts.   
 
If you are not a contracted MA PPO provider with BlueCross BlueShield of South Carolina and you provide services for any Blue Medicare Advantage members, you will receive the Medicare-allowed amount for covered services. For urgent or emergency care, the members’ Blue Plans will reimburse you at the members’ in-network benefit levels. Other services will be reimbursed at the out-of-network benefit levels.

How do I recognize an out-of-area member from one of these Plans participating in the BlueCross MA PPO network sharing?

A member who participates in the MA PPO Network Sharing program will have an ID card with an “MA” in a suitcase. We have asked members not to show their standard Medicare ID cards when they receive services. Instead, members should show their BlueCross and/or BlueShield member ID cards.   
  
View additional information on MA PPO Network Sharing

If you have additional questions, contact Provider Education via e-mail at Provider.Education@bcbssc.com or by phone at 800-288-2227, ext. 44730.

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