Medicare Advantage FAQs

NOTE: These FAQs focus only on services for Medicare Advantage members.

How will I know that a non-network member would like me to provide services to them?

Will I need to provide services to all non-network members?

What steps do I need to take when providing services to a non-network member?

How do I obtain a Member Servicing Confirmation Form?

Does a non-network member have a unique identification card?

How do I file a claim for a non-network member?

How will I be paid for services rendered to a non-network member?

What is the Medicare allowed amount?

Who do I contact if I have additional questions regarding non-network members?

How will I know that a non-network member would like me to provide them services?
You may be contacted by a member or us and asked if you would provide medical services to a non-network member.

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Will I need to provide services to all non-network members?
You are currently not required to render services to non-network members; although we do encourage you to provide service.

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What steps do I need to take when providing services to a non-network member?
You should complete the following steps when providing services to a non-network member:

• Verify eligibility and bill for services for any out-of-state Blue Plan member you agree to treat
• Verify benefits by referring to the number on the member's ID card
• Complete a Member Servicing Confirmation Form. (By completing this form, you are agreeing to provide services to a particular member for the period of time indicated on the form at the Medicare Allowed Amount.)
• Submit form to us at network.administration@bcbsla.com or fax to 225.297.2750.

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How do I obtain a Member Servicing Confirmation Form?
You may obtain a form on our website in the BlueCard Out of State section on the Servicing Medicare Advantage Members page. Submit the form via e-mail to network.administration@bcbsla.com or fax to 225.297.2750.

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Does a non-network member have a unique identification card?
Non-network members will have an identification card that will look the same as other members of the same employer group. All Medicare Advantage cards will have the Medicare Advantage PPO/suitcase-type logo.

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How do I file a claim for a non-network member?
Claims are to be submitted directly to Blue Cross and Blue Shield of Louisiana via your standard claims submission processes.

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How will I be paid for services rendered to a non-network member?
Providers will be paid the "Medicare allowed amount" based on where the services were rendered and under the member's out-of-network benefits.

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What is the Medicare allowed amount?
The Medicare allowed amount is the fee schedule reimbursement that Medicare would pay to a provider who accepts assignment of benefits for services rendered to a member.

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Who do I contact if I have additional questions regarding non-network members?
Contact Provider Services at 1.800.922.8866 options 3 or contact your Provider Relations Representative. To verify benefits, refer to the number on the member's ID card.

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