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Blue Advantage Questions and Answers

What is the difference between Blue Advantage and the original Medicare program?

The original Medicare program is operated by the Centers for Medicare & Medicaid Services (CMS). Blue Advantage is a Medicare Advantage Preferred Provider Organization (PPO) Plan, offered and administered by Blue Cross and Blue Shield of Alabama. Blue Advantage is designed to give beneficiaries access to comprehensive, affordable healthcare coverage with a strong emphasis on disease management, prescription drug benefits, preventive health services and coordinated care.

Will this product replace C Plus?

Blue Advantage will not replace our current C Plus product. C Plus is a supplemental policy to traditional Medicare. There will be Medicare beneficiaries who choose to stay with the traditional Medicare program and may select C Plus as their Medicare supplement. Blue Advantage is an alternative to the traditional Medicare program. An individual selecting Blue Advantage would no longer have traditional Medicare as their primary insurance and would not need a supplemental policy.

Is there a Blue Advantage Provider Network?

Yes, providers must participate with Medicare. In addition, providers must be participating providers in any applicable Preferred or Participating Program with Blue Cross. Blue Advantage participating providers must sign a participation agreement.

Will there be a Blue Advantage Provider Directory?

Yes, Blue Advantage members are provided a directory of participating providers. Blue Advantage providers in their area are also posted to the Blue Cross website, AlabamaBlue.com.

How will a Blue Advantage participating provider be reimbursed?

Blue Advantage is a Blue Cross product so providers will be reimbursed based on a contracted fee schedule subject to applicable copayments and deductibles as described in the member’s benefits that are available through ProviderAccess or your practice management software system.

What if a provider is not a Blue Advantage participating provider?

Providers who are not participating in the Blue Advantage program will be subject to out-of-network benefits and are subject to the Medicare Limiting Charge and all the applicable rules for Medicare non-participating providers.

What kind of benefits will the Blue Advantage member have?

Even though Blue Advantage is a Blue Cross product, we are required to ensure that any member has at least the same benefits that they would have if they were enrolled in traditional Medicare. We may not choose to cover the benefits in the same way that Medicare covers and the benefits may be greater but they cannot be less than traditional Medicare. The benefits are available electronically through ProviderAccess or your practice management software system.

Do I file claims to Medicare?

All claims for Blue Advantage members should be filed to Blue Cross. Do not file claims to Medicare.

What number do I call for Customer Service?

Inquiries for Blue Advantage members should be made through the same means as for any other Blue Cross subscriber. Click here for a listing of Blue Cross contact information.