6 de diciembre de 2021
We’re offering certain Blue Cross Medicare AdvantageSM members a new way to access care. The Blue Cross Medicare Advantage Flex (PPO)SM Plan is an open access plan. It allows members to see any provider accepting Medicare, including Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM contracted providers. Members can see providers inside or outside the plan service area or plan network, at no additional cost.
What This Means for You
- Starting Jan. 1, 2022, you can identify Flex Plan members by their member ID card. Look for the Flex Plan name on the front.
- You can see Flex Plan members if you accept Medicare and bill Blue Cross and Blue Shield of New Mexico (BCBSNM). Follow the billing instructions on the member ID card.
- If you are a Medicare Advantage-contracted provider with Blue Cross and Blue Shield (BCBS), you will be paid at your contracted rate.
- If you are not a Medicare Advantage-contracted provider with BCBS, you will receive the Medicare allowed amount for covered services. You may not balance bill the member for any difference in your charge and the allowance.
Value for Members
Flex Plan members' coverage level is the same whether in or outside the plan service area nationwide. Services must meet medical necessity criteria to be covered. The Flex Plan includes:
- Cobertura para medicamentos con receta
- MDLIVE® for telehealth and 24/7 Nurseline
- SilverSneakers® fitness program at no cost
- A traveler benefit for members leaving their service area for up to six months
Check Eligibility and Benefits First
Use la Availity® Provider Portal 
or your preferred vendor to verify members' eligibility and benefits before every appointment. Eligibility and benefit quotes include:
- Membership verification
- Coverage status
- Prior authorization requirements
- Provider’s network status for the member’s policy
- Applicable copayment, coinsurance and deductible amounts
Ask to see the member's ID card and a photo ID to help guard against medical identity theft. If services may not be covered, members should be notified that they may be billed directly.
Availity es una marca registrada de Availity, LLC, una compañía aparte que opera una red de información de salud para prestar servicios de intercambio de información electrónica a profesionales médicos. Availity presta servicios administrativos a BCBSNM.
MDLIVE is a separate company that has contracted with BCBSNM to provide virtual visit services for members with coverage through BCBSNM. MDLIVE es el único responsable de sus operaciones y de las de sus profesionales médicos contratados. Virtual visits may not be available to all BCBSNM members.
SilverSneakers is a wellness program owned and operated by Tivity Health, Inc., an independent company. Tivity Health y SilverSneakers son marcas comerciales registradas o marcas comerciales de Tivity Health, Inc. o sus subsidiarias o afiliadas en los EE. UU. u otros países.
BCBSNM no aprueba, representa ni garantiza ninguno de los productos o servicios ofrecidos por los proveedores externos. If you have any questions about the products or services provided by the vendor, you should contact the vendor directly.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Los beneficios se determinarán una vez que se reciba el reclamo y se basarán, entre otras cosas, en la elegibilidad del asegurado y los términos del certificado de asegurado de la cobertura aplicable en la fecha en la que se prestaron los servicios.