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        • Supporting Caregivers
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 1-800-678-2265      TTY: 711

8:00 a.m. to 8:00 p.m. ET, Seven Days a Week.

  • Shop Plans
    • 2023 Plans
      • 2023 Medicare Advantage Plans
        • Medicare PPO Blue SaverRx
        • Medicare PPO Blue ValueRx
        • Medicare PPO Blue PlusRx
        • Medicare HMO Blue SaverRx
        • Medicare HMO Blue ValueRx
        • Medicare HMO Blue FlexRx
        • Medicare HMO Blue PlusRx
      • 2023 Medicare Supplement Plans
        • Medex Core
        • Medex Sapphire
        • Medex Bronze
        • Medex Vision & Hearing
      • 2023 Prescription Drug Plans
      • 2023 Dental Plans
      • 2023 Group Plans
      • 2023 Travel Medical Insurance Plans
  • Learn More
    • Intro to Medicare
      • Introduction
      • Eligibility and Enrollment
      • Frequently Asked Questions
      • Your Coverage Choices
      • Original Medicare
      • Medicare Advantage
      • Prescription Drug Coverage
      • Plan that’s Right for you
      • Sign-Up for a Guide Book and Email
      • Medicare Basics Video Series
    • Are You Eligible For Medicare?
    • Are Your Drugs Covered?
    • Attend a Seminar
    • About Medicare
      • Health Plan Basics
      • Important Dates
    • Request a Call
  • Health & Wellness
    • Finding Care
      • 24-Hour Nurse Line
      • Care Management
      • ER Alternatives
      • Find a Doctor
      • Member Support & Assistance Program
        • In-home Care from Landmark Health
        • In-home Health Assessments with Signify Health®´
        • Personalized Support for Disease Management
        • Quality Optimizer
        • Additional Programs
      • Mental Health
      • Supporting Caregivers
    • Manage Your Health
      • Managing Diabetes
      • Preventive Care
      • Flu Prevention
      • Chronic Care
      • Fall Prevention
      • Urinary Incontinence
      • Meals and Nutrition
  • Member Resources
    • Plan Information
      • Plan Documents
      • Quality Assurance
      • National Coverage Determination
      • Ending Membership
    • Pharmacy Benefits
      • Drug Benefits
        • Home Delivery
        • Formulary Overview
        • Coverage Requirements
        • Formulary Changes
      • Medicare Advantage Pharmacy Network
      • Plan Drug Transition Policy
      • Medication Therapy Management
      • Prescription Drug Utilization Review
    • Learn to Live
    • Get More With MyBlue
    • Discounts & Programs
    • Payment Options
    • Fraud & Disaster
    • Appeals & Grievances
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Quality Assurance

Learn how we make sure your care and coverage meets the highest quality standards.

Primary Care Incentives and Hospital Quality Improvement

Our Primary Care Physician Incentive Plan and Hospital Quality Improvement Plan allow both providers and hospitals to participate in an incentive program that rewards them for meeting certain nationally-recognized quality standards and patient safety goals. Doctors must choose to participate in this program, and you can check to see if your physician group participates by using our Find A Doctor tool.

Quality Improvement Initiatives

Per our Centers for Medicare and Medicaid Services (CMS) contract, annually we implement new Quality Initiatives that will help improve how members manage their care and health. One of the initiatives we are proud to promote is our Case Management Program—our solution for members managing complex health conditions. If you’re identified in this program, a registered nurse case manager will call you to:

  • Assess your health needs
  • Provide education about your symptoms, condition, and medication
  • Help you follow your doctor’s treatment plan
  • Collaborate with you to develop health care goals
  • Help you develop self-management skills
  • Collaborate and coordinate care with your doctors
  • Inform you about community resources
  • Assist you in understanding your health plan benefits

Learn more about Care Management Program

Chronic Condition Management

Our Chronic Condition Management program is a voluntary service offered at no cost to members managing one or more chronic health conditions. This program is designed to help members with the day-to-day management of conditions such as coronary artery disease, diabetes, and other chronic conditions. If you're invited to participate, you have the right to decline, but we recommend you take full advantage of the assistance the program can provide.

This information is not a complete description of benefits. Call 1-800-200-4255 (TTY: 711) for more information.

Blue Cross Blue Shield of Massachusetts is an HMO and PPO Plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of Massachusetts depends on contract renewal. Anthem Insurance Companies, Inc., Blue Cross and Blue Shield of Massachusetts, Inc., Blue Cross & Blue Shield of Rhode Island, and Blue Cross and Blue Shield of Vermont are the legal entities that have contracted as a joint enterprise with the Centers for Medicare & Medicaid Services (CMS) and are the risk-bearing entities for Blue MedicareRx (PDP) plans. The joint enterprise is a Medicare-approved Part D Sponsor. Enrollment in Blue MedicareRx (PDP) depends on contract renewal.

You can file a complaint if you feel that you received inaccurate, misleading or inappropriate information. Please call Member Service at 1-800-200-4255 (TTY users call: 711). If your complaint involves a broker or agent, be sure to include the name of the broker/agent when filing your complaint.

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Last Updated: 01/01/2023

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Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. ®, ℠ Registered and Service Marks of the Blue Cross and Blue Shield Association. ®' Registered Marks of Blue Cross Blue Shield of Massachusetts. ®’’, ℠´, ™ Registered Service and Trade Marks are property of their respective owners. ©   Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.

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