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Anthem Blue Cross : Anthem Medicare Preferred PPO

Anthem Medicare Preferred PPO

PW_A114247
Plan & Administrative Changes/Updates for Providers:
Click here for important Medicare Advantage updates! 
Anthem Medicare Preferred PPO from Anthem Blue Cross Life & Health Insurance Company is a Medicare Advantage Preferred Provider Organization plan available to Medicare beneficiaries in California.  
Anthem Medicare Preferred Standard (PPO) will be available in the following counties: Los Angeles, San Diego, and Ventura (Service Area 1); Orange, San Francisco and Sonoma (Service Area 2); Riverside, San Bernardino and San Mateo (Service Area 3); Alameda, Sacramento, Santa Clara and Stanislaus (Service Area 4).
Anthem Medicare Preferred PPO allows its members to use the services of any physician, hospital, or other provider within the plan’s network. Click here to search for a participating provider.
No referrals to see network physicians or specialist
Members must satisfy plan deductible before plan benefits begin. Please see either the 2012 Summary of Benefits or the 2013 Summary of Benefits.
Members can also use providers outside of the Freedom Blue network, however member cost are higher.
Pre-certification required for specific services. (See Summary of Benefits)
Freedom Blue PPO features a Medicare Part D prescription drug benefit. Click here for network of pharmacies
 
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.

Explanation of: What Beneficiary Notice Form to Use

Beneficiary Notice Forms (click health plan form below to retrieve)

- NOMNC Notice of Medicare Non-Coverage.

- DENC Detailed Explanation of Non-Coverage.

- NDMC Notice of Denial of Medical Coverage.

- NDP Notice of Denial of Payment.

Beneficiary Notice Forms (on http://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
 
Additional Information
Medicare Advantage Out of Network Payment Guide
Beneficiary Notice Forms

IM Important Message from Medicare

Detailed Notice of Discharge

 
Medicare Advantage HMO & PPO Provider Guidebook
(Formerly know as the Medicare Advantage HMO & PPO Provider Manual)
Independent Provider Payment Dispute Process
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 Blue Cross Life & Health encourages our providers to participate in 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 under browse by Special Topic.  
We want to be sure you have no reservations about providing services to our members.  
We invite you to learn more about Freedom Blue PPO.  
 
 

® Anthem is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association © 2011 Anthem Blue Cross.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.