Blue Cross Medicare Advantage (PPO)^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 (PPO) Service Areas

Atascosa, Bastrop, Bandera, Bexar, Burnet, Caldwell, Cameron, Chambers, Collin, Colorado, Comal, Cooke, Dallas, Denton, El Paso, Fannin, Fayette, Fort Bend, Galveston, Gonzales, Guadalupe, Hardin, Harris, Hays, Hidalgo, Hill, Hood, Jefferson, Johnson, Kendall, Lamp, Lee, Liberty, Llano, Matagorda, McMullen, Medina, Milam, Montgomery, Navarro, Real, Rockwall, Tarrant, Travis, Wharton, Willacy, Williamson, Wilson and Wise counties.

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

Archer, Austin, Bee, Bell, Blanco, Bosque, Brazoria, Brooks, Burleson, Clay, Coryell, Dimmit, Duval, Ellis, Erath, Falls, Freestone, Goliad, Grimes, Hamilton, Henderson, Hopkins, Houston, Jack, Jim Hogg, Jim Wells, Karnes, Kenedy, La Salle, Limestone, Madison, Mason, McCulloch, McLennan, Mills, Nueces, Orange, Palo Pinto, Parker, Polk, Rains, Refugio, San Jacinto, San Patricio, San Saba, Shackelford, Somervell, Throckmorton, Trinity, Tyler, Van Zandt, Walker, Waller, Washington, Webb, and Zavala counties.

Network Participation

Blue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (PPO) plan.

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

Retiree Group Medicare Plans

Our retiree group Medicare plans are Blue Cross Group Medicare Advantage (PPO), Blue Cross Group Medicare Advantage Open Access (PPO)^SM and Blue Cross Group MedicareRx (PDP)^SM. BlueStages^SM is a Medicare supplement insurance plan that helps cover some costs beyond what is covered by Original Medicare.

Have questions?

Please contact your Network Management office.

Claims

Participating physician, professional provider, facility or ancillary providers must submit claims to Blue Cross Medicare Advantage (PPO) within 90 days of the date of service, using the standard claim form or electronically. Services billed beyond 90 days from date of service are not eligible for reimbursement. Blue Cross Medicare Advantage (PPO) participating physician, professional provider, facility or ancillary providers may not seek payment from the member for claims submitted after the 90-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 Choice PPO^SM Physicians, Professional Providers, Facility and Ancillary Providers
• Blue Cross Medicare Advantage PPO Supplement  
• Blue Cross Medicare Advantage PPO Orientation  
• Sample Blue Cross Medicare Advantage PPO Member ID Card  
• Sample Blue Cross Group Medicare Advantage Open Access (PPO) Member ID Card 
• Medicare Advantage Waiver of Liability