Dec. 7, 2020, Update: We have updated the Diabetic Supplies section below to include the two manufacturers for diabetic test strips. Also, as a reminder, the information below will go into effect on Jan. 1, 2021.
On Oct. 8, 2020, we communicated that Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would be offering enhanced Medicare Advantage benefits along with the new Healthy Blue + Medicare Dual-Eligible Special Needs Plan (D-SNP), effective Jan. 1, 2021. If you are a provider currently participating in our Medicare Advantage product, Blue Medicare, you will also be included in Healthy Blue + Medicare and will not be required to sign a new agreement with Blue Cross NC. You will automatically be added to the network.
Healthy Blue + Medicare is offered pursuant to a contract between CMS and Blue Cross and Blue Shield of North Carolina Senior Health, a wholly-owned subsidiary of Blue Cross NC. Healthy Blue + Medicare is an included MA plan for all Blue Cross NC Medicare Provider Agreements, and its members are served by the same network that serves all other MA plans offered by Blue Cross NC. The amounts due, bundling edits, policies and procedures may differ based on the specific product as a result of different benefit designs and claims adjudication methodologies. Claims will be paid consistent with current contract provisions, and Blue Cross NC will use its best efforts to apply bundling logic that is consistent with industry AMA HCPCS (Level I and Level II) or CMS CCI standards in effect at the time of the date of service.
Additional information and a Blue Cross NC Healthy Blue + Medicare provider resource page will be provided at a later date. In the meantime, see below for more details:
D-SNP Supplemental guide and sample ID card
Click here to see a sample of the D-SNP supplemental guide and member benefits. D-SNP supplemental guide will be posted at BlueCrossNC.com. The sample ID card is posted below.
Providers in the Community Eye Care Blue Medicare network will be in-network for the Healthy Blue + Medicare medical vision benefits. Routine vision services are not covered through the Healthy Blue + Medicare (HMO D-SNP) medical vision network. All medical claims for vision care for Healthy Blue + Medicare members should be submitted to the address on the back of the member’s ID card.
Please refer to the member benefits guide linked above for routine vision care on the “More Healthy Benefits” page.
Members requiring diabetic test strips (diabetic supplies) will only be covered through their pharmacy network. Test strips are limited to two manufacturers: Ascensia and LifeScan. These supplies will not be covered as in-network when supplied by durable medical equipment providers. This applies to our Medicare Advantage HMO and PPO benefits.
Provider training and attestation requirements
The Centers for Medicare & Medicaid Services (CMS) requires all contracted providers and staff receive basic training about the D-SNP Model of Care. This training and completion of an attestation are required for new providers and annually thereafter. Additional information regarding training will be provided at a later date.