Blue Cross Medicare Advantage (HMO)^SM and Blue Cross Medicare Advantage Dual Care (HMO SNP)^SM

Blue Cross Medicare Advantage plans offer all the same coverage as Original Medicare — plus benefits not covered by Medicare or most Medicare Supplement insurance plans, including built-in prescription drug coverage and extra health and wellness options. Blue Cross and Blue Shield of Texas (BCBSTX) offers both individual and group Medicare Advantage plans.

Blue Cross Medicare Advantage (HMO) Service Areas

Atascosa, Bandera, Bastrop, Bexar, Burnet, Caldwell, Cameron, Chambers, Collin, Comal, Dallas, Denton, El Paso, Fort Bend, Hardin, Harris, Hays, Hidalgo, Jefferson, Kendall, Lee, Liberty, Medina, Montgomery, Orange, Tarrant, Travis, Webb, Willacy, Wilson and Williamson counties.

Additional Blue Cross Medicare Advantage (HMO) Service Areas effective 1/1/2022

Brazoria, Ellis, Johnson, Parker, Rockwall, and Waller counties.

Blue Cross Medicare Advantage (HMO SNP) Service Areas

Atascosa, Bandera, Bastrop, Bexar, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Collin, Colorado, Comal, Coryell, Dallas, Denton, Falls, Fayette, Gonzales, Grimes, Guadalupe, Hays, Hill, Kendall, Lampasas, Lavaca, Lee, Leon, Limestone, Llano, Madison, Medina, Milam, Mills, Navarro, Robertson, Rockwall, San Saba, Somervell, Tarrant, Travis, Williamson and Wilson counties.

View the Blue Cross Medicare Advantage HMO SNP provider training here .

Retiree group Medicare plans

Our retiree group Medicare plans include Blue Cross Group Medicare Advantage (HMO)^SM. This plan provides group Medicare members access to providers within a defined network, with no out-of-network benefit.

Network Participation

New individual providers, new medical groups desiring to apply for network participation and existing medical groups who wish to add additional providers to their current contract, will need to complete the Provider Onboarding Form

Have questions?

Please contact your Network Management office.

Claims

Participating physicians and professional providers must submit claims to Blue Cross Medicare Advantage HMO and DSNP within 180 days of the date of service, using the standard claim form or electronically. Services billed beyond 180 days from date of service are not eligible for reimbursement. Blue Cross Medicare Advantage HMO and DSNP participating physicians and professional providers may not seek payment from the member for claims submitted after the 180-day filing deadline.

• Availity
• Claim Status

 

Blue Cross Medicare Advantage Provider Quick Reference

Blue Cross Medicare Advantage Provider Quick Reference 

Join the Network

To join our Blue Cross Medicare Advantage network, refer to How to Join.

Prior Authorization Requirements

• Blue Cross Medicare Advantage PPO^SM and Blue Cross Medicare Advantage HMO^SM section
• eviCore Preauthorization Program

Medicare Marketing Guidelines

All providers who contract with BCBSTX to provide Medicare Advantage services are expected to abide by the Centers for Medicare & Medicaid Services (CMS) rules for marketing when it involves BCBSTX or Blue Cross Medicare Advantage products or benefits.

• Medicare Marketing Guidelines 
• Medicare Marketing Guidelines Update Memo 080619  
• Medicare Marketing Guidelines Dos and Don't's 

Resources

• Blue Essentials^SM, Blue Advantage HMO^SM, Blue Premier^SM and MyBlue Health^SM Provider Manual
• Blue Cross Medicare Advantage HMO and DSNP Supplement 
• Blue Cross Medicare Advantage HMO and DSNP Orientation 
• Blue Cross Medicare Advantage HMO and DSNP Member ID Card Sample 
• Medicare Advantage Waiver of Liability 
• Blue Cross Medicare Advantage Dual Care (HMO SNP) Model of Care training