Name of Manual - Blue Cross and Blue Shield of Minnesota

Guidelines for
Determining
Submissions to
Medicare or Blue Cross
Inquiries and Claims
Platinum Blue (Cost)
Health Care Options
For services provided to Medicare members enrolled in our
Medicare supplement or Platinum Blue plan that are eligible under
Medicare Part A, Medicare is primary. CMS will continue to be
the primary payor for these services with electronic claims
crossing over from Medicare intermediaries. Blue Cross will serve
as secondary payor for these services with members being subject
to Medicare coinsurance and deductibles.
Blue Cross is the administrator for Medicare Part B nonfacilitybased
services and any additional Platinum Blue benefits.
Reimbursement for professional providers utilize Blue Cross’
contracted fee schedule methodology. Current reimbursement uses
2005 RVUs with Medicare conversion factors and is GPCI
adjusted (geographical adjustment). For the initial product launch,
Medicare part B services will apply CCI edits at the claim level; as
Blue Cross’ functionality evolves; auto adjudication will occur. To
ensure CMS compliance, follow the guidelines outlined in
standard Medicare bulletins and the Provider Policy and Procedure
manual.
For Medicare members enrolled in our Medicare Advantage plans,
including MedicareBlue PPO, Blue Cross replaces Medicare as
primary payor. Please see the information available on medical
policy, claims submission and payment, etc at:
http://www.yourmedicaresolutions.com/for_providers/
Provider claim and benefit inquiries for Platinum Blue can be
directed to provider web self-service, BLUELINE or provider
services at (651) 662-6500 or 1-800-262-0820.
Care management inquires should be directed to (651) 662-5520 or
1-800-528-0934.
Services eligible under Medicare part B and that would otherwise
be billed to the Medicare carrier on a professional claims
form/format, should be submitted directly to Blue Cross
electronically, whenever possible.
Group number for Platinum Blue individual members are:
• Y0704 - C0 - Platinum Blue Core Option
• Y0704 - C4 - Platinum Blue Core Option-Medicare B only
members
• Y0704 - H1 - Platinum Blue Core Option - Medicare Hospice
enrolled members
• Y0705 - C0 - Platinum Blue Choice Option
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 5-15