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Introducing Blue Medicare

Blue Cross and Blue Shield of North Carolina (BCBSNC) is the parent company of PARTNERS National Health Plans of North Carolina, Inc. (PARTNERS), a health care company based in Winston-Salem. If you're not already familiar with PARTNERS, this Medicare Advantage organization provides HMO and PPO plans for approximately 43,000 people within the state.

Recently, PARTNERS received a license to identify itself as an affiliate of the Blue Cross and Blue Shield Association. This affiliate designation allows PARTNERS HMO and PPO products to be branded with the Blue Cross and Blue Shield symbols, replacing the Medicare Choice HMO and Medicare Options PPO products with the new Blue Medicare HMO^SM and Blue Medicare PPO^SM.

Beginning January 1, 2008, both Blue Medicare HMO and Blue Medicare PPO will be available in 37 counties in North Carolina, including areas within the Triangle, Triad and Charlotte regions. Blue Medicare HMO and Blue Medicare PPO are replacement products for PARTNERS Medicare Choice HMO and Medicare Options PPO.

Effective January 1, 2008, Blue Medicare HMO and Blue Medicare PPO members have new identification cards featuring a "blue" look. These new cards display the Blue Cross and Blue Shield symbols and are for members who have health care coverage with PARTNERS. This means that when arranging health care and/or submitting claims for services provided to Blue Medicare HMO and Blue Medicare PPO members, PARTNERS in Winston-Salem remains the main contact. Even with this change, we’ve worked to make the member cards distinctive, so you can easily determine whether a claim or question should be directed to PARTNERS or BCBSNC. Please see the sample card image below:

Blue Medicare sample card image

With a quick glance of the front of the card, you can see in the upper right hand corner that the member has a Blue Medicare plan and the type of plan the member has chosen is also specified.* Just below that, you’ll see an area shaded in blue that highlights the plan as offered by PARTNERS, which is identified as a BCBSNC company. On the left hand side of the card, you'll note that the Blue Medicare member’s ID includes an alpha prefix. Blue Medicare alpha prefixes are unique to Blue Medicare members and always end with the letter J. The following alpha prefixes identify Blue Medicare plan types:

YPWJ - Blue Medicare HMO

YPFJ - Blue Medicare PPO

YPJJ - Blue Medicare HMO for Reynolds American Inc. retirees

It’s easy to distinguish between Blue Medicare HMO members and Blue Medicare PPO members. Just look at the alpha prefix at the beginning of the member’s Blue Medicare identification code. The alpha prefix YPWJ lets you know that the member’s coverage type is an HMO plan. If you see YPFJ, you’ll know the coverage type is PPO. Additionally, Reynolds American Inc. retirees have a customized alpha prefix of YPJJ, making them easy to identify as having an individualized HMO plan. Any time that you are presented with one of these alpha prefixes, you’ll know that the claims and health care services are administered by PARTNERS.

The back of a Blue Medicare member’s identification card provides further information about arranging health care services and claim submission with PARTNERS. The cards also display the PARTNERS claims mailing address and telephone service lines.

*Providers should be aware that neither an individual’s possession of a Blue Medicare member identification card nor information contained in this mailing represents a guarantee of member’s benefits, eligibility or coverage in a Blue Medicare plan. A member’s actual Blue Medicare eligibility and benefits should always be verified in advance of providing services.

Important information about Blue Medicare:
You need to know!

Blue Medicare ID cards are readily recognizable, but remember that the cards include both BCBSNC and PARTNERS information. It’s important that you review the cards carefully and note the Blue Medicare alpha prefixes and PARTNERS health plan information. Don’t be confused by the Blue Cross and Blue Shield Association symbols and BCBSNC written text. Always remember that Blue Medicare is offered by PARTNERS National Health Plans of North Carolina, Inc., a BCBSNC company. Because of this, the following basic rules apply:

• Only providers directly contracted with PARTNERS National Health Plans of North Carolina, Inc. (PARTNERS) are considered as in-network for Blue Medicare HMO and Blue Medicare PPO. Participation with BCBSNC does not extend to Blue Medicare HMO and/or Blue Medicare PPO.
• BCBSNC participating providers that are not contracted with PARTNERS can provide services to Blue Medicare PPO members as part of the member’s PPO out-of-network benefits.
• Blue Medicare HMO members have no out-of-network benefits (except for emergency care).
• Blue Medicare plans have unique alpha prefixes:
  
  • YPWJ – Blue Medicare HMO (no out-of-network benefits – emergency care only)
  • YPFJ – Blue Medicare PPO (out-of-network benefits available)
  • YPJJ – Blue Medicare HMO (most services require referrals from Winston-Salem Health Care)
• Providers participating with both BCBSNC and PARTNERS cannot use Blue e electronic transactions for Blue Medicare HMO and PPO claims and/or member information.
• Claims submitted to BCBSNC for Blue Medicare HMO and PPO members in error will be returned to the submitting provider or electronic clearinghouse. This includes both paper and electronic claims.
• BCBSNC health coaching services, claims processing, post adjudication review and medical policy do not apply to Blue Medicare HMO and Blue Medicare PPO. These services and functions are administered by PARTNERS at its Winston-Salem location.

Interested in seeing Blue Medicare members?

If your health care location participates with BCBSNC but not with PARTNERS, please contact your local network management field office to find out how your health care business can become an in-network provider for Blue Medicare HMO and/or PPO members.

Blue Medicare product logos

New product logos make Blue Medicare HMO and Blue Medicare PPO plans more recognizable as an affiliate of the Blue Cross and Blue Shield Association. However, the name Blue Medicare also applies to BCBSNC prescription and supplemental plans as shown below.

Distinguishing among Blue Medicare product types

As you can see, the logos for the BCBSNC products and PARTNERS products appear very similar. However, you can easily distinguish between BCBSNC products and PARTNERS products with the following information:

1. Logos for Blue Medicare HMO and Blue Medicare PPO¹ both include text in their design that reads: "Offered by PARTNERS National Health Plans of North Carolina, Inc."
2. Logos for Blue Medicare HMO and Blue Medicare PPO include either an HMO or PPO designation in their design.

Reminder: When filing claims for Blue Medicare, always send claims for Blue Medicare HMO and Blue Medicare PPO services to PARTNERS National Health Plans of North Carolina, Inc. Claims for Blue Medicare Rx^SM and Blue Medicare Supplement^SM should be filed with BCBSNC.²