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MediBlue PPO

PW_AD092911
Plan & Administrative Changes/Updates for Providers:
Click here for important Medicare Advantage updates!  
MediBlue PPO is a family of Medicare Advantage PPO plans for Medicare beneficiaries. MediBlue PPO is available through a contract with the federal government.  
MediBlue PPO plans include all of the benefits offered under Medicare Part A and Part B, plus many other important benefits that Medicare beneficiaries may need. See the 2012 Summary of Benefits or the 2013 Summary of Benefits for more details.  
Additional Information
Medicare Advantage Out of Network Payment Guide
 
FAST TRACK APPEALS 

Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Medicare Advantage (MA) Programs. Financial liability, appeal rights, and protections are communicated to beneficiaries through notices given by providers or the MA health plan. Download the forms and instructions below.

Beneficiary Notice Forms (click health plan form below to retrieve)  
NOMNC Notice of Medicare Non-Coverage. 

Empire Blue Cross

Empire Blue Cross Blue Shield

DENC Detailed Explanation of Non-Coverage.  

Empire Blue Cross

Empire Blue Cross Blue Shield

NDMC Notice of Denial of Medical Coverage. 

Empire Blue Cross

Empire Blue Cross Blue Shield

NDP Notice of Denial of Payment. 

Empire Blue Cross

Empire Blue Cross Blue Shield

Beneficiary Notice Forms (on www.cms.hhs.gov/bni

IM Important Message from Medicare

Detailed Notice of Discharge

Institutional billing codes are available from the NUBC via the NUBC's Official UB-04 Data Specifications Manual. To be redirected to NUBC click here
ID card
Independent Provider Payment Dispute Process
Medicare Advantage HMO & PPO Provider Guidebook
(Formerly know as the Medicare Advantage HMO & PPO Provider Manual) 
Medicare Coverage Homepage
Medicare Part D Coverage Determination Request Form (for use by provider)
Affordable Care Act (ACA)
Formerly known as Patient Protection and Affordable Care Act  
Precertification Requirements
*Medicare Advantage Products never require Pre-Existing Condition signoff
Precertification Form Empire BC
Precertification Form Empire BCBS
Preventive Health Guidelines
Quick Reference Guide to the CMS 1500
Revision of Definition of Compendium in the Medicare Benefit Policy Manual; Chapter 15; Section 50.4.5
 
Empire encourages our providers to participate in the CMS and HHS quality improvement initiatives. To learn more about these initiatives or find new announcements, please visit http://www.cms.hhs.gov/home/medicare.asp and scroll to the bottom of the page under the section “Browse by Special Topic.”  
We want you to be sure you have no reservations about providing services to our members. We invite you to learn more about MediBlue PPO plans.  
©2014 Empire BlueCross BlueShield

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.