Blue Cross Medicare Products

Mandatory CMS compliance requirement – Training on Fraud, Waste and Abuse

Providers that contract with Blue Cross to provide health, prescription or administrative services to Medicare enrollees must meet the Centers for Medicare & Medicaid Services (CMS) education and training requirements related to fraud, waste and abuse. Effective January 1, 2011, CMS changed the requirements so that most providers will not need to demonstrate to Blue Cross that they have met these requirements.

You are not required to take the Blue Cross Medicare Fraud, Waste and Abuse training if:

• You are enrolled in the original fee-for-service Medicare program, including providers that accept assignment or bill claims to original Medicare; and
  
• You are Medicare Part C medical provider OR a Medicare Part D DME, prosthetics, orthotics and supplies (DMEPOS) provider.

If you do not meet the above, you are required to take the training offered by Blue Cross or another Medicare Advantage Organization or Part D Plan Sponsor. The training and accompanying attestation form must be completed annually.

Training module (PPT)
Attestation form (PDF)

Product details

View the product guide (PDF) for a complete list of products for Medicare beneficiaries.

What’s changed

Recent public policy developments have resulted in the most significant changes to Medicare in 30 years. Many health plans are either broadening their Medicare product options or offering Medicare products for the first time. Some of the recent developments are:

• The Medicare Modernization Act (MMA) passed -- shifts the emphasis from supplemental plans administered by CMS to Medicare Advantage products administered by health plans
  
• The introduction of Part D stand-alone prescription drug coverage
  
• The conversion of DHS’s Minnesota Senior Health Options (MSHO) from a state-based program to a CMS Special Needs Plan (SNP), resulting in a SNP unique to the rest of the nation (Medicare/Medicaid benefits)
  
• Baby boomers are aging; the number of people over the age of 55 will grow from 36 million today to 77 million by 2011

How providers benefit

Blue Cross has been offering Medicare products for more than 20 years. We have expanded our offerings to meet the changing needs of seniors. We are also simplifying claims administration for providers:

• For some products, there will be no crossover from Medicare
  
• There’ll be less cost sharing to collect from the member (in most instances; this will be in the form of copayments rather than coinsurance)
  
• It’ll be easier to refer patients to specialists – most plans are open access with no need for referral paperwork

Medicare Secondary Payer (MSP) information

Providers are required to report any potential Medicare Secondary Payer information to Medicare. Blue Cross does not require the fulfillment of CMS' MSP information. Under Medicare Advantage Plans, enrollees turn over their Medicare Part A and Medicare Part B to Blue Cross when they become enrolled in one of our Medicare plans, such as MedicareBlue PPO or SecureBlue. For Blue Cross members that have selected our VantageBlue product, the MSP would not be required for the Medicare Part B services, but would be required for the Part A services that are processed by Medicare (Noridian). However, Blue Cross will inquire with the subscriber about secondary payer information at least once a year as it does currently today for its other Blue Cross products. Learn more about MSP (PDF).