CIS
What is the group # for MBG contracts?
90500
What Button must be checked off in Blue Advantage (Dors)?
All
Providers must be PPO with Medicare Advantage yes or no?
Yes
What is the SPPG Code for Blue Advantage participating "DME" and Part "B" drugs for Pharmacy
SPPG code DS
Should you check OIC to see if the member has Medicare/Medicaid?
Yes you should always check OIC for every contract.
In Dors what web link must you click on while working with MBG contracts?
Blue Advantage
What SPPG code must AL providers have?
MD
Is Medicare Advantage individual or group plans?
Individual.
Where is the OIC subtab located?
On the Subscriber tab
What prefix does Blue Advantage contracts start with?
MBG
True or False - If an instate provider has the MD SPPG code the provider is out of network?
False they are in network
What Medicare Part C is called?
Medicare Advantage
What tab do you click on to see if the member has Blue Advantage, Health or dental etc. "X" on their contract?
Subscriber tab and detail subtab.
True or False - You do not have to check BOL for Blue Advantage contracts?
False
True or False - Medicare Advantage is the network that out-of-state providers use
True
Medicare Part C includes Hospital (Part A), Physician (Part B), and what is Part D
Prescription Drug Coverage
What tabs should you check for to see if the member has Blue Advantage?
Subscriber tab - Detail SubTab
Coverage tab BOL
Where can additional information for MAPPO be found?
"Dors" Blue Advantage
If a service is rendered by a non participating provider is it considered in or out of network?
O.O.N
For Blue Advantage contracts do we transfer the provider to Carelon?
NO!