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Providers

Blue Medicare

Blue Medicare HMO | Blue Medicare PPO | Healthy Blue + Medicare (D-SNP)

Healthy Blue + Medicare (D-SNP)

View D-SNP resources, training and contact information.

Hold Harmless Policy

Some Blue Medicare members will not be held financially responsible for covered services under certain conditions.

Prescription drug formulary

Search for a drug in Blue Cross NC's Medicare formulary.

HCC risk adjustment coding

View documentation for coding diagnoses and services.

Resources and forms

Get the forms you need to do business with Blue Cross NC.

Medical management programs and services

Learn more about the programs and services Blue Medicare HMO and Blue Medicare PPO plans have implemented to maintain the high quality care for members.

Case management programs

Some members of Blue Medicare HMO and PPO are eligible to work one-on-one with a case manager. Learn how patients may qualify.

Flu shot program

Members can get a flu shot at their provider’s office from October through November while supplies last.

Quality Improvement Program

Learn more about how we aim to maintain the highest quality of treatment for our Blue Medicare members.

Policies, guides and codes

Medical, reimbursement, administrative policies and guidelines

Service and procedure (CPT) codes

Responsibilities of primary care physicians (PCP)

Effective 1/1/2008, Blue Medicare HMO and Blue Medicare PPO members have the freedom to choose in-network providers and specialists without a referral. Members are still expected to select a primary care physician (PCP). Members are encouraged to visit their PCP before seeing a specialist. In this way, Blue Medicare HMO and Blue Medicare PPO PCPs are still able to coordinate generally for the overall care management for their patients.

  • Family practice/general practice doctors provide care for infants, children, adolescents and adults in the areas of community medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery.
  • Internists (internal medicine) provide service for treatment of diseases in adults. Normally, they do not deliver babies, treat children or perform surgery.
  • Pediatricians typically treat children from birth up to the age of sixteen.
  • Geriatric doctors provide care for older adults.