Blue Cross Medicare Advantage (HMO)℠
BCBSTX was approved to offer, effective Jan. 1, 2016, a Medicare Advantage preferred provider plan that offers improved health benefits for Medicare beneficiaries. Blue Cross Medicare Advantage affords more comprehensive benefits at a lower cost for Medicare beneficiaries, whenever they access care through a participating provider.
If you are located in Bastrop, Burnet, Caldwell, Cameron, Chambers, El Paso, Fort Bend, Hardin, Harris, Hays, Hidalgo, Jefferson, Lee, Liberty, Montgomery, Orange, Webb, Willacy or Williamson counties, BCBSTX would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (HMO) plan. Additionally, as of Jan. 1, 2018, BCBSTX Medicare Advantage became effective in the following counties Atascosa, Bandera, Bexar, Comal, Kendall, Medina and Wilson.
BCBSTX believes that our long standing history in providing affordable health care coverage to the people of Texas, our strong brand recognition, and our historical relationship with Medicare makes BCBSTX an excellent choice for seniors seeking new health coverage opportunities.
BCBSTX needs your network participation for this program to be successful. In order to participate in Blue Cross Medicare Advantage HMO, physicians and professional providers:
- Must be a participating Blue EssentialsSM physician or professional provider
- Must have privileges at one of the Blue Cross Medicare Advantage HMO participating hospitals (unless inpatient admissions are uncommon or not required for the physician's or professional provider's specialty)
- Must have a valid National Provider Identifier (NPI) number
- Must sign a Blue Cross Medicare Advantage HMO amendment to his/her Blue Essentials agreement
- Cannot have opted-out of Medicare or have any sanctions or reprimands by any licensing authority or review organizations
To request an Medicare Advantage HMOSM Network Participation Agreement, please use the Network Participation Online Request Form.
Note: Additional credentialing will not be required for those physicians or professional providers already credentialed in the Blue Essentials network and whose re-credentialing is current.
If you have any questions regarding this plan and are interested in participating, please feel free to contact your Network Management office.
Or go to How to Join BCBSTX Provider Networks and follow the steps.
- Blue EssentialsSM, Blue Advantage HMOSM and Blue PremierSM – Physician, Professional Provider, Ancillary and Facility Provider Manual
- Blue Cross Medicare Advantage HMO Supplement
- Blue Cross Medicare Advantage HMO Orientation
- Blue Cross Medicare Advantage HMO Key Contacts List
- Blue Cross Medicare Advantage HMO Member ID Card Sample
- Blue Cross Medicare Advantage HMO SNP Member ID Card Sample
- Effective 01/01/2018 – through 05/30/2018 — BCBSTX Medicare Advantage CPT Preauthorization Code List
- Effective 05/31/2018 – through 08/31/2018 — BCBSTX Medicare Advantage Preauthorization Procedure Code List effective 5/31/2018
- Effective 09/01/2018 — BCBSTX Medicare Advantage Preauthorization Procedure Code List effective 09/01/2018
- Blue Cross Medicare Advantage HMO Preauthorization Request
- Blue Cross Medicare Advantage HMO Quick Reference Guide
- Medicare Marketing Guidelines
- Medicare Advantage Waiver of Liability