Medical Management Programs and Services
This section provides information about programs and services Blue Medicare HMO and Blue Medicare PPO plans have implemented to maintain the high quality care for its members.
Health Care Services
Blue Medicare HMO and Blue Medicare PPO follow review processes for evaluating certain health care services before, during and after those services have been performed.
Case Management Programs
In certain health situations, members of Blue Medicare HMO and Blue Medicare PPO are eligible to work one-on-one with a case manager. Learn how patients may qualify.
Quality Improvement Program
The Quality Improvement Program for the Blue Medicare HMO and Blue Medicare PPO plans is an important component of the products. Learn more about how the plans we aim to maintain the highest quality.
Medication Therapy Management Program
Medication therapy management program (MTMP), designed for targeted members to help ensure that covered Part D drugs are appropriately used to optimize therapeutic outcomes by improving medication use and reducing the risk of adverse drug events, including adverse drug interactions.
Flu Shot Program
From October through November, while supplies last, members can receive a flu shot at their primary care physician's office or contracting specialist's office, if offered. They can also receive a flu shot at flu clinics sponsored by Blue Medicare HMO and Blue Medicare PPO plans.
Blue Cross and Blue Shield of North Carolina (BCBSNC) is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. BCBSNC does not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC is an independent licensee of the Blue Cross and Blue Shield Association.