Blue Medicare PPO is a Medicare Advantage product offered by Blue Cross and Blue Shield of Texas. It is a preferred provider organization (PPO) plan offered to Medicare Part A and B Members in the following 5 approved Texas counties:

• El Paso
• Galveston
  (NOTE: limited to the Mainland portion of Galveston county)
• Harris
• Jefferson
• Montgomery

Blue Medicare PPO maintains and monitors a network of Participating Providers including physicians, practitioners, hospitals, skilled nursing facilities, ancillary providers and other providers through which Members obtain Covered Services. Although selection of a Primary Care Physician (PCP) is not required, Members are encouraged to have their PCP coordinate their care with specialty care physicians/professional providers. Members may self-refer to specialty care physicians/professional providers.

Blue Medicare PPO does not have a "gate keeper" and the Member can see a specialist without a referral from a primary care physician. There are services that will require a precertification. To access the precertification list, click on the following link - Blue Medicare PPO Precertification Requirements List. If you have services to precertify, you can access iEXCHANGE Web or by calling the iEXCHANGE Interactive Voice Response (IVR) System at 1-800-413-0869.

To participate in the Blue Medicare PPO, physicians/professional providers:

• Must be a Participating BlueChoice Physician/Professional Provider
• Must have privileges at one of the Blue Medicare PPO participating hospitals (unless inpatient admissions are uncommon or not required for the physician's/professional provider's specialty)
• Must have a valid National Provider Identifier (NPI) Number
• Must sign a Blue Medicare PPO amendment to his/her BlueChoice agreement, and
• Cannot have opted-out of Medicare or have any sanctions or reprimands by any licensing authority or review organizations. Blue Medicare PPO Participating Physicians/Professional Providers cannot be named on the Office of the Inspector General (OIG) or Government Services Administration (GSA) lists which identify physicians/professional providers found guilty of fraudulent billing, misrepresentation of credentials, etc. Blue Medicare PPO Participating Physicians/Professional Providers cannot be sanctioned by the Office of Personnel Management or be prohibited from participation in the Federal Employees Health Benefit Program (FEHBP).

To participate in the Blue Medicare PPO, facilities and other ancillary providers:

• Must be a Participating BlueChoice Facility or Ancillary Provider
• Must sign a Blue Medicare PPO amendment to the BlueChoice agreement, and
• Cannot have opted-out of Medicare or have any sanctions or reprimands by any licensing authority or review organizations. Blue Medicare PPO Participating Facilities/Ancillary Providers cannot be named on the Office of the Inspector General (OIG) or Government Services Administration (GSA) lists which identify facilities found guilty of fraudulent billing, misrepresentation of credentials, etc. Blue Medicare PPO Participating Facilities/Ancillary Providers cannot be sanctioned by the Office of Personnel Management or be prohibited from participation in the Federal Employees Health Benefit Program (FEHBP).

Blue Medicare PPO is a product of HCSC Insurance Services Company (HISC), a wholly owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

For more detailed information about Blue Medicare PPO, click on the links located in the box to the left.