Dec. 4, 2024
Beginning this month, you will be reimbursed at Medicare-like rates for some self-funded Tribal organizations who have new benefit plans. Medicare-like rates will be applied for eligible claims, such as facility claims for inpatient, outpatient, emergency room and freestanding ER services. This is according to section 506 of the Medicare Modernization Act of 2003.
What this means: Hospitals must accept Medicare-like rates as payment in full for services provided to beneficiaries of some self-funded Tribal employer plans.
How to identify members: The member ID card contains language indicating that Medicare-like rates may be applied for eligible claims. Continue to submit claims to Blue Cross and Blue Shield of New Mexico, as directed on the ID card.
Questions: Call the number on the member ID card for help.