Medicare AdvantageAdministrativeHigh impact
MA00.010at, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Independence Blue Cross·Physical Therapy, Radiology, PM&R (Physical Medicine & Rehab)·Network
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
This policy establishes PPO Network Rules for specialty services including Durable Medical Equipment (DME), Laboratory, Radiology, and Physical Medicine/Rehabilitative Services under Medicare Advantage plans. The policy, effective April 1, 2025, defines network requirements and billing rules for these service categories that billing teams must implement immediately.
Action Required
By April 1, 2025: Billing team must review and implement MA00.010at PPO Network Rules in billing software and workflows. Specific actions required: (1) Verify all DME, Laboratory, Radiology, and Physical Medicine/Rehabilitative service claims are submitted only to in-network providers per this policy; (2) Update claim submission rules and provider networks in billing system to reflect new PPO network requirements; (3) Train billing staff and providers on the specific network rules outlined in the full policy text; (4) Review and update encounter forms and billing checklists to ensure compliance with network requirements. Access full policy at: https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=04&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#medicare-advantage-ma00-010at-ppo-network-rules-for-provisio. Claims submitted outside network parameters or not following these rules will be denied or subject to non-covered benefits.