Jump to Content
We've chosen a plan model, private fee-for-service, that allows us to pay you based on Original Medicare rates.
Reimbursement
You'll receive reimbursement based on Original Medicare rates
Private fee-for-service plans use the same reimbursement methodologies as Original Medicare to pay health care providers including:
- Medicare fee schedules
- Prospective payment systems
- Interim Medicare payment amounts
- Bonus payments in health professional shortage areas and physician scarcity areas
Learn more about Medicare's fee schedules and methodologies.*
There are exceptions for prescription drugs and for Medicare Plus Blue PFFSSM members with network requirements for durable medical equipment, prosthetic and orthotic appliances, or medical supplies.
When can you expect payment?
All private fee-for-service plans are required to process 95 percent of all clean claims within 30 days of receipt.
Reimbursement for dental providers
Medicare Plus Blue PPO and some Medicare Plus Blue PFFS plans provide coverage for routine dental procedures as an enhanced benefit. These procedures are typically performed and billed by general dentists.
Oral surgeons who perform routine dental procedures for Medicare Plus Blue PPO members must have a dental PIN in order to be reimbursed by BCBSM dental. Reimbursement will be based on the traditional dental fee schedule. Refer to your 2009 Guide for Dental Care Providers for more information.
