Provider Secured Services

Home > Provider Home > Medicare Advantage > BCN Advantage

BCN Advantage HMO^SM

BCN Advantage is Blue Care Network's Medicare Advantage plan. BCN Advantage combines the benefits of original Medicare Parts A and B with additional coverage to create a health care plan offering Medicare coverage and much more.

For 2010, BCN Advantage is offered in 31 counties in Michigan. The BCN Advantage provider network is a subset of the BCN commercial provider network.

To learn more about BCN Advantage, select from the options below which take you to information available on BCN's site:

• Network
• Service area
• Benefits information
• General information for BCN Advantage members

---

Provider Resources

Use the links below to find out more about:

• BCN Advantage Formulary
• Requesting Prescription Drug Coverage

Quality Interchange Program

The Quality Interchange Program is the cornerstone of BCN Pharmacy Services' efforts to ensure high-quality pharmaceutical care while reducing costs. This step-therapy and prior authorization program manages the use of certain medications for which there are equally effective, less costly alternatives available.

• Review the drugs included in the program and criteria for use (PDF)

Quantity Limits

Prescriptions covered under BCN's drug riders are generally limited to a 34-day supply when dispensed by a retail pharmacy and 90 days through our mail order service. BCN has established quantity limits for certain medications based either on package size or to promote appropriate prescribing of drugs intended for once daily dosing.

• BCN Advantage Quantity Limits (PDF)

Fraud, Waste and Abuse

The Centers for Medicare and Medicaid Services requires all entities and their employees who partner with Medicare Advantage organizations and prescription drug plans to complete annual training to detect, prevent, and correct fraud, waste, and abuse. Records of that training, including participant names, must be retained and available for inspection upon request. To assist our Medicare partners in meeting this requirement, BCBSM and BCN have developed a slide presentation available below for your use. Instructions on how to report fraud are also included below.

• Fraud, Waste and Abuse Training (PDF)
• Report Fraud

---

Need Additional Information?

Additional BCN Advantage information is available on web-DENIS, within our secure provider portal including:

• Provider Manual Chapter
• BCN Advantage Formulary
• Notice of Medicare Non-Coverage for skilled nursing facilities and home health providers

Go directly to BCN Advantage information on web-DENIS (log in with your user ID and password).

Or, gain access from our Provider Welcome Page.

1. Log in using your web-DENIS user ID and password.
2. Select BCN Provider Publications and Resources
3. Under Products, select Government Programs to browse available BCN Advantage documents

For more information about BCN Advantage, call BCN Provider Inquiry at 1-800-255-1690.