Blue Medicare

Policies and Responsibilities

This section provides information about policies and responsibilities that Blue Medicare HMO and Blue Medicare PPO plans have implemented to maintain the high quality care for its members.

• Responsibilities of primary care physicians (PCPs)

• Reimbursement Policy - Quality Incentive Program

• Hold harmless policy

• Medicare Sequestration Alignment Policy

• Multiple Radiology Services Reimbursement Policy

• Credentialing and contracting

• Prior authorization

• Specialty networks

• Post-Service Provider Appeals

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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.