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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 resources