Blue adVantage (HMO) | Blue adVantage (PPO)

Plus sign that becomes an "X" when the accordion collapses to show more content New/Revised Medicare Advantage Medical Policies

The Medicare Advantage (MA) Plan must follow all traditional Medicare NCDs and LCDs applicable to the MA Plan’s service area per 42 CFR § 422.101. When coverage criteria are not fully established in traditional Medicare statutes, regulations, NCDs or LCDs (applicable to the MA Plan’s service area), internal coverage criteria can be developed. Internal coverage criteria may be similar or the same as criteria found in LCDs that are applicable outside the MA Plan’s service area, as long as, the criteria are based on current evidence in widely used treatment guidelines or clinical literature and is made publicly available. This policy is to serve as the summary of evidence, a list of resources and an explanation of the rationale that supports the adoption of the coverage criteria and is to be used by all plans and lines of business unless Federal or State law, contract language, including member or provider contracts, take precedence over the policy.

Current Policies

New Policies Effective Jan. 1, 2025

Revised Policies Effective Jan. 1, 2025

HMO Louisiana, Inc. offers Blue Advantage (HMO). Blue Cross and Blue Shield of Louisiana offers Blue Advantage (PPO). Both are independent licensees of the Blue Cross and Blue Shield Association.

Blue Advantage from HMO Louisiana, Inc. is an HMO plan with a Medicare contract. Blue Advantage from Blue Cross and Blue Shield of Louisiana is a PPO plan with a Medicare contract. Enrollment in either Blue Advantage plan depends on contract renewal.

Blue adVantage Support

Customer Services

For full Blue adVantage online provider services, such as claim status checks, member eligibility, benefit verification or confirmation of prior authorization, use our Blue adVantage Provider Portal. Visit iLinkBlue, then click on “Blue Advantage” under the “Other Sites”