Medicare Advantage
We serve members through many different plans, including Florida Blue’s Medicare Advantage Plan members. If you participate in our BlueDental Choice Copayment (PPO) network, you are considered an in-network provider for Florida Blue’s Medicare Advantage members. These members have a Medicare HMO or PPO medical plan, with embedded dental PPO. Reimbursement is paid according to the BlueDental Choice Copayment PPO schedule of allowances, which you can find in the Fee Schedules.
Treating Medicare Advantage members
Members will present to your office with a Florida Blue BlueMedicare HMO or PPO Medicare Advantage ID card. To verify benefits, please refer to MyPatientsBenefits or contact Customer Service at 866-445-5148. You can find samples of the benefit plans and member ID cards in our Dental Manual.
If a service isn’t covered by a member’s Medicare Advantage benefit plan, you are required by law to inform members in writing and in advance of treatment, outlining their financial responsibility.
If you have opted out of participation with Medicare, you are prohibited from providing services to Medicare members. If you provide services, you will not be reimbursed by Florida Combined Life. In addition, you are required by law to inform members in writing, and in advance of treatment, that you do not participate and they will be responsible for all charges.
CMS required training
All providers who participate with Medicare Advantage are required by The Centers for Medicare & Medicaid Services (CMS) to complete fraud, waste and abuse training annually. To access this training:
- Visit CMS’s training site
- Go to “Fraud and Abuse-related Resources”
- Click on “Fraud and Abuse Educational Products”
- Follow the instructions for accessing the web-based training and downloadable PDF versions
Once you have completed the required training, please complete the
Where to find more information
You can find more information, including ID card examples, in our Dental Manual.