Medicare Advantage Provider
Policy and Procedures
- Medicare Advantage Provider Manual
- Understanding Star Ratings Guides
- Specific Billing Guidelines
- Annual Physical Exam Policy
- Benefits Summary for Blue Medicare Advantage (PPO) and Blue Medicare Advantage Comprehensive (PPO): Northeast Region
- Benefits Summary for Blue Medicare Advantage (PPO) and Blue Medicare Advantage Comprehensive (PPO): South Central Region
- Benefits Summary for Blue Medicare Advantage Choice (PPO): All Regions
- Blood and Blood Components Policy
- Dental Care Benefit Policy
- Dental e-Payment Options
- Member Benefit Highlights and Cost-Sharing (Availity login required)
- Fitness Benefit Policy
- Hearing Care Policy
- Inpatient Hospital Care Policy
- Meal Benefit Policy
- Medical Policy Hierarchy
- Organ Acquisition Costs Policy
- Over-the-Counter Benefit
- Symphony Provider Portal Training Guide
- Transplant Travel Benefits Policy
- Vision Care Policy
- Worldwide Coverage Emergency Care Policy
Medical management Resources
Education
Newsletters
- 09/05/2023 - Billing Hemoglobin A1c Labs for Blue MA Patients
- 05/15/2023 - MA refraction coverage update
- 05/04/2023 - Symphony 6.0 is coming on Monday, June 5th, 2023
- 03/28/2023 - 2023 Blue Medicare Advantage Stars Incentive Program
- 01/30/2023 - Medicare Advantage Claims for Unlisted and Not Otherwise Classified (NOC) Codes
- 12/13/2022 - Pharmacy Benefit Manager (PBM) Change for BCBS MA Medicare Advantage
- 10/26/2022 - Updating and Certifying Provider Data in the Centers for Medicare & Medicaid Services’ National Plan & Provider Enumeration System
- 03/23/2022 - Sequestration Resumes
- 12/22/2021 - Medicare Advantage Home Health Billing Update
- 11/23/2021 - Manage osteoporosis to limit disability
- 10/12/2021 - Help improve diabetic patient health while reducing medical record review requests
- 09/20/2021 - Encourage eligible Medicare Advantage patients to get screened for colorectal cancer
- 08/20/2021 - Remind your eligible patients to get regular mammograms
- 07/16/2021 - Remember to discuss fall risk, urinary incontinence, and physical activity with Medicare patients
- 06/11/2021- Importance of statin therapy for patients with cardiovascular disease and diabetes
- 05/12/2021 - Medication reconciliation post-discharge is critical to patient safety and care coordination efforts
- 04/13/2021 - Blood pressure coding can reduce HEDIS® medical record requests
- 03/17/2021 - Advanced illness and frailty exclusions allowed for HEDIS® star measures
- 03/09/2021 - New Medicare Advantage Payment Method – EFT and Paper Remittance
- 02/26/2021 - Telehealth visits available to Medicare Advantage patients including annual wellness visits
- 02/24/2021 - Gain insights from CAHPS research on improving the patient experience
- 02/23/2021 - UNDERSTANDING STAR RATINGS - An introduction to the Centers for Medicare & Medicaid Services star ratings program
- 02/15/2021 - New MA Alpha Prefix with New Look
- 12/11/2020 - Medicare Advantage Prior Authorization Change (Updated 12/23/2020)
- 11/18/2020 - Medicare Advantage Interim Rate Letters
- 11/12/2020 - COVID-19 Vaccine Coverage
- 05/20/2020 - Temporary Suspension of Sequestration (Updated 03/23/2022)
- 05/13/2020 - Remote Electronic Medical Records Access
- 03/20/2020 - Kansas Preferred Blue Medicare Advantage Utilization Management Changes Due to COVID-19
- 12/17/2019 - Welcome to Medicare Advantage
Medicare Advantage Workshops
- 2023 Medicare Advantage Workshop
- Medicare Advantage 101 workshop presentation slides (PowerPoint deck)
- Medicare Advantage 101 workshop frequently asked questions
Medicare Advantage Risk Adjustment Tip Sheets
- Active vs Historical Status of Malignancies
- Acute Conditions Not Usually Treated in an Office Setting
- Annual Wellness Visit Q&A
- Body Mass Index
- CDI Alert Completion Tips
- CDI Alert Queries Q&A
- Chronic Kidney Disease and Secondary Hyperparathyroidism of Renal Origin
- Diabetes Mellitus and Its Complications
- Documentation Tips for Risk Adjustment Volume 1
- Documentation Tips for Risk Adjustment Volume 2
- Documentation Tips for Risk Adjustment Volume 3
- Documenting Conditions Managed by Specialist
- MEAT Guidelines
- Remote CDI completion tips
- Stroke or Cerebrovascular Accident (CVA)
Medicare Advantage Stars Tip Sheets
- Please see the Understanding STAR Ratings Manual document above. As these items have been combined into that document.
Webinars
- 02/18/2020 - Tru Hearing Medicare Advantage
- 01/16/2020 - Medicare Advantage webinar recording with Q&A
Forms
Prior Authorization Assessment
- Acute Inpatient Hospital Admission
- Long Term Acute Care Hospital (LTACH)
- Skilled Nursing Facility (SNF) Rehabilitation
Advance Benefit Notices
- Advanced Directives
- Advanced Beneficiary Notice of Non-Coverage (ABN) (compressed zip file)
- Detailed Explanation of Non-Coverage (DENC) (compressed zip file)
- Medicare Outpatient Observation Notice (MOON)
- Notice of Medicare Non-Coverage (NOMNC) (compressed zip file)
Satisfaction Surveys
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey
- Medicare Health Outcomes Survey
Waiver of Liability
- Model Waiver of Liability (compressed zip file)