Blue Medicare

Specialty networks

• Community Eye Care

• Laboratory Services / Reference Labs

Community Eye Care / Medical Eye Care

Blue Medicare HMO and Blue Medicare PPO plans are contracted with Community Eye Care to provide medical/routine vision care to members using a panel of optometrists and ophthalmologists.

• No referral needed
• Direct access to contracting Ophthalmologists and Optometrists
• Routine vision
• Medical surgical

Laboratory Services / Reference Labs

If a specimen is drawn and the laboratory work is sent to a reference lab, the only service billable to Blue Medicare HMO and Blue Medicare PPO members is the administrative/handling charge (i.e., 36415-venipuncture). The reference lab will bill directly to Blue Medicare HMO or Blue Medicare PPO for the services it provides.

In-office labs
If a provider is performing the laboratory service in their office, and their lab is CLIA certified, the services can be filed directly with Blue Medicare HMO or Blue Medicate PPO for reimbursement.

Note: Selected counties are subject to Blue Medicare HMO and Blue Medicare PPO Laboratory Office Allowable Lists. Under that program only procedures included in the appropriate Office Allowable Lists can be billed directly to Blue Medicare HMO and Blue Medicare PPO. Questions regarding this lab program should be directed to your Strategic Provider Relationships Consultant.

Exhibit A
Physician offices with Physician Performed Microscopy (PPM) certification or unrestricted (full) CLIA certification may bill Blue Cross NC directly for procedures included in the appropriate Office Allowable List. All procedures not listed should be sent to any Blue Cross NC participating reference lab or participating hospital lab.

Office Allowable List for Physician offices with Physician Performed Microscopy (PPM) certification or unrestricted (full) CLIA certification

Exhibit B
Physician offices with documented CLIA-waived certification may bill Blue Cross NC directly for procedures included in the appropriate Office Allowable List. All procedures not listed should be sent to any Blue Cross NC participating reference lab or participating hospital lab.

Office Allowable List for Physician offices with documented CLIA-waived certification

To view PDF documents you need Adobe Acrobat Reader.

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.