Medicare Advantage

 

The City of New York has awarded their group retiree business to the Retiree Health Alliance, an alliance between Empire BlueCross BlueShield (Empire) and EmblemHealth. Effective January 1, 2022, approximately 240,000 Medicare-eligible City of New York retirees across the United States will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan.

 

The NYC Medicare Advantage Plus plan is a Medicare Advantage PPO plan that allows retirees to receive services from both in-network and out-of-network providers. Out-of-network providers must be eligible to receive Medicare payments to provide care to NYC retirees. Under this new plan, City of New York retirees will have no difference in cost-share for both in-network and out-of-network services. NYC Medicare Advantage Plus offers the same hospital and medical benefits covered by original Medicare as well as additional benefits original Medicare does not provide, such as an annual routine physical exam, hearing, health and fitness tracker, LiveHealth Online,* and SilverSneakers.*

 

Retirees enrolled in NYC Medicare Advantage Plus will have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing effective January 1, 2022. Recently, you may have received calls from City of New York retirees inquiring if you are participating or if you accept NYC Medicare Advantage Plus. Retirees may also refer to the new plan as Medicare Advantage Plus or the Alliance.

 

Currently, City of New York retiree claims are processed by Medicare as primary and then by Empire for facility services or EmblemHealth for professional services as supplemental coverage under the General Health Insurance/Empire Senior Care plan.

 

Beginning January 1, 2022, under the NYC Medicare Advantage Plus plan, providers will change billing processes as follows:

  • Providers should submit all claims (facility, professional, and ancillary) to your local Blue plan:
    • For independent clinical laboratories, providers should file to the BCBS Plan where the referring provider is located.
    • For durable/home equipment and supplies (D/HME), providers should file to the BCBS Plan where the equipment was shipped to or purchased from in a retail store.
  • Providers should not transmit any claims to original Medicare.
  • Claims can be submitted electronically or by paper submission (UB-04or CMS-1500 form) to your local Blue plan.

 

For additional information, review the NYC Medicare Advantage FAQ at anthem.com/da/inline/pdf/abscare-1134-21.pdf.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield. LiveHealth Online is an independent company providing online doctor visits on behalf of Empire BlueCross BlueShield. SilverSneakers is an independent company providing fitness management on behalf of Empire BlueCross BlueShield.

ABSCRNU-0278-21



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