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Reminder: Medicare Advantage PPO network sharing billing procedures

March 1, 2012

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Claims for Blue Cross? Blue Shield? Medicare Advantage PPO members who travel or reside in our 5-county Philadelphia service area should be submitted to IBC for processing.

For dates of service beginning January 1, 2011, IBC was required by the Blue Cross and Blue Shield Association (BCBSA) to participate in the BCBSA national Medicare Advantage PPO Network Sharing Program. This program mandates that we accept Medicare Advantage PPO enrollees from other Blue Cross Blue Shield Plans who travel or reside in our 5-county Philadelphia service area as our local members. Claims for these members should be submitted to IBC for processing for dates of service on or after January 1, 2011.

We previously communicated these procedures in a letter sent to participating providers in September 2010, as well as in Partners in Health UpdateSM from September 2010 through December 2010; however, Highmark continues to receive these claims in error. These claims will continue to be rejected and returned to providers with direction to resubmit claims to IBC for proper handling.

If you have any questions regarding this claims submission process, please contact your Network Coordinator.

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