Blue Cross Medicare AdvantageSM Plans

Medicare Advantage plans offer all the coverage of Original Medicare — plus benefits not covered by Medicare or most Medicare Supplement insurance plans, including built-in prescription drug coverage and extra health and wellness options. Blue Cross and Blue Shield of Montana (BCBSMT) offers both individual and group Medicare Advantage plans.

  • Our service area includes the following counties in Montana: Carbon, Cascade, Flathead, Gallatin, Lake, Lewis and Clark, Lincoln, Missoula, Ravalli, Silver Bow, and Yellowstone. We are expanding in Jefferson, Broadwater, Granite, Powell, and Deer Lodge Counties for Medicare Advantage, effective 1/1/2022.

Our strong brand recognition and our historical relationship with Medicare makes BCBSMT an excellent choice for Medicare-eligible individuals. We maintain and monitor a network of participating providers including physicians, hospitals, skilled nursing facilities, ancillary providers, and other health care providers through which members obtain covered services.

  • Our retiree group Medicare plans are Blue Cross Group Medicare Advantage (PPO)SM and Blue Cross Group Medicare Advantage Open Access (PPO)SM.

Out-of-network Note: If you see Medicare members or accept Medicare assignment and are willing to bill BCBSMT, you may treat Blue Cross Group Medicare Advantage Open Access (PPO) members. These members enjoy the same level of coverage as other Medicare Advantage members with no network restrictions. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. In-network providers will be paid at their contracted rate. For eligibility, prior authorization or claims inquiries, call 877-299-1008.

  • Claims

    Participating physicians, professional providers, and facility providers must submit claims to Blue Cross Medicare Advantage within 365 days of the date of service, using the standard CMS-1500 or UB-04 claim form, or electronically. Services billed beyond 365 days from the date of service are not eligible for reimbursement.

    Paper Claim Mailing Address and Fax

    Blue Cross Medicare Advantage
    P.O. Box 3686
    Scranton, PA 18505

    New Payer ID (66006) – Beginning Jan. 1, 2017, Payer ID 66006 must be included on electronic claims received for Blue Cross Medicare Advantage PPO and Blue Cross Medicare Advantage HMO members. Blue Cross Medicare Advantage claims received with the commercial Payer ID (BCBS) will not be accepted.*

    *If you utilize a practice management/hospital information system or billing service, and/or a clearinghouse other than AvailityTM or HeW for electronic claim submission, please contact your vendor to confirm they are using the new Payer ID for the alpha prefixes referenced above, rather than assigning their own unique number.

  • Contact Us

    Provider Claims Address

    Payment cycles for electronic funds transfers (EFT) will be changing from daily to weekly.

    Blue Cross Medicare Advantage (Claims)
    P.O. Box 3686
    Scranton, Pa. 18505
    EDI Claims Payer ID 66006
    Appeals Address Blue Cross Medicare Advantage
    Attention: Appeals Department
    PO Box 663099
    Dallas, TX 75266
    Standard Appeals Fax Number 1-800-419-2009
    Expedited Appeals Fax Number 1-800-338-2227
    Grievances Address Blue Cross Medicare Advantage
    Attn: Grievances Department
    PO Box 4288
    Scranton, PA 18505
    Grievances Fax Number 1-855-674-9189
    Provider Disputes Blue Cross Medicare Advantage
    P O Box 4555
    Scranton, PA 18505
    Medical Records Blue Cross Medicare Advantage
    P O Box 4555
    Scranton, PA 18505
    Member Reimbursement Claims Blue Cross Medicare Advantage
    P.O. Box 4195
    Scranton, PA 18505
    RPO, VOP, and EPIC – Claims Address PO Box 2888
    Houston, TX 77252-2888
    Magellan Claims Address P.O. Box 1289
    Maryland Heights, MO 63043

    Refund Address:

    ERM (Electronic Refund Management), claims refund and inquiry process post 1/1/17 will not be available through ERM

    Blue Cross Blue Shield of Montana
    Claims Overpayments
    Dept. CH 14212
    Palatine, IL 60055-4212

    Courier Address:
    Blue Cross and Blue Shield of Montana Claims Overpayments
    Box 14212
    5505 N. Cumberland Ave.
    Suite 307
    Chicago, IL 60656-1471
    Customer Service Phone Numbers Individual: 1-877-774-8592
    Group: 1-877-299-1008

     

  • Join the Network

     

    To join our Blue Cross Medicare Advantage network, follow the process for Network Participation.

  • Prior Authorization Requirements

  • Resources