Los Angeles Unified School District (LAUSD) Offers Medicare Advantage Option
Effective January 1, 2019, Los Angeles Unified School District (LAUSD) began offering an Anthem Medicare Preferred (PPO) plan. Retirees with Medicare Parts A and B are eligible to enroll in the Anthem Medicare Preferred (PPO) plan. The plan includes the National Access Plus benefit, which allows retirees to receive services from any provider, as long as the provider is eligible to receive payments from Medicare.
Non-contracted providers may continue treating LAUSD members and will be reimbursed 100% of Medicare’s allowed amount for covered services, less any member cost share.
LAUSD members’ copay or coinsurance percentage are the same whether his/her provider is in- or out-of-network. Locally or nationwide, doctors or hospitals, in- or out-of-network — the member’s cost share doesn’t change.
The MA plan offers the same hospital and medical benefits that Medicare covers and also covers additional benefits that Medicare does not, such as an annual routine physical exam, hearing, vision, chiropractic care, acupuncture, LiveHealth Online and SilverSneakers®.
The prefix on LAUSD cards is MBL. The cards also show the LAUSD logo and National Access Plus icon.
Providers may submit claims electronically using the electronic payer ID for the Blue Cross and Blue Shield plan in their state or submit a UB-04 or CMS-1500 form to the Blue Cross and Blue Shield plan in their state. Claims should not be filed with Original Medicare. Contracted and non-contracted providers may call the provider services number on the back of the member ID card for benefit eligibility, prior authorization requirements and any questions about LAUSD member benefits or coverage.
Detailed prior authorization requirements also are available to contracted providers by accessing the Provider Self-Service Tool at Availity.com.
February 2019 Anthem Blue Cross Provider Newsletter - California