Blue Cross Medicare Advantage (PPO)SM
If you are located in Bastrop, Bexar, Burnet, Caldwell, Chambers, Collin, Dallas, Denton, Fayette, Fort Bend, Hardin, Harris, Hays, Jefferson, Lee, Liberty, Montgomery, Tarrant, Travis, or Williamson counties, Blue Cross and Blue Shield of Texas (BCBSTX) would like to extend the opportunity to you for participation as a provider in the Blue Cross Medicare Advantage (PPO) plan.
Blue Cross and Blue Shield of Texas (BCBSTX) was approved to offer, effective Jan. 1, 2013, a Medicare Advantage preferred provider plan that offers improved health benefits for Medicare beneficiaries. Blue Cross Medicare Advantage PPO affords more comprehensive benefits at a lower cost for Medicare beneficiaries, whenever they access care through a participating provider.
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 PPO, physicians, professional providers, facility and ancillary providers:
- Must be a participating Blue Choice PPOSM physician, professional provider, facility and ancillary provider
- Must have privileges at one of the Blue Cross Medicare Advantage PPO participating hospitals (unless inpatient admissions are uncommon or not required for the physician's, professional provider's or facility or ancillary provider's specialty)
- Must have a valid National Provider Identifier (NPI) number
- Must sign a Blue Cross Medicare Advantage PPO amendment to his/her Blue Choice PPO 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 PPOSM Network Participation Agreement, please use the Network Participation Online Request Form.
Note: Additional credentialing will not be required for those physicians, professional providers, facility or ancillary providers already credentialed in the Blue Choice PPO network and whose recredentialing 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 Choice PPO Physician, Professional Provider, Facility or Ancillary Provider - Provider Manual
- Blue Cross Medicare Advantage PPO Supplement (Physician, Professional Providers, Facility and Ancillary Providers)
- Blue Cross Medicare Advantage PPO Orientation
- Blue Cross Medicare Advantage PPO Key Contacts List
- Sample Blue Cross Medicare Advantage PPO Member ID Card
- Effective 1/1/2017 through 5/31/17 — Blue Cross Medicare Advantage PPO Preauthorization Requirements List
- Effective 6/1/2017 through 12/31/2017 — Blue Cross Medicare Advantage PPO Preauthorization Requirements List
- Effective 01/01/2018 — Blue Cross Medicare Advantage CPT Preauthorization Code List
- Blue Cross Medicare Advantage PPO Preauthorization Request
- Blue Cross Medicare Advantage PPO Quick Reference Guide
- Blue Cross Medicare Advantage PPO Medicare Part B Medication Prior Authorization Request Form
- Medicare Marketing Guidelines
- Medicare Advantage Waiver of Liability