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Anthem Medicare Local Preferred Provider Organization (LPPO)

PW_AD090986
Plan & Administrative Changes/Updates:  
Click here for important Medicare Advantage updates! 
Anthem Medicare Preferred from Anthem Blue Cross and Blue Shield is a Medicare Advantage Preferred Provider Organization health plan available to Medicare Beneficiaries in select counties in the states of Connecticut, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia and Wisconsin. 

Anthem Medicare Preferred PPO is available to anyone with Medicare Parts A&B

Anthem Medicare Preferred PPO allows its member to use the services of any physician, hospital or other provider within the plan’s network. Click here to search for a participating provider.

 

Members must satisfy plan deductible before plan benefits begin. Click here for summary of benefits: 2012 Summary of Benefits / 2013 Summary of Benefits

Members can also use providers out side of the Anthem Medicare Preferred network, however member cost are higher.

Pre-certification required for specific services. (See Summary of Benefits)

Anthem Medicare Preferred PPO features a Medicare Part D prescription drug benefit. Click here for network pharmacies

 
To participate in this plan, contact your local provider representative. 
 
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. To download the forms click here.

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

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

 
Anthem 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 to be sure you have no reservation about providing services to our members. We invite you to learn more about Anthem Medicare Preferred. 
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use