Community Blue Medicare HMO · Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt...

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Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt Effective Jan. 1, 2016, Highmark is offering Community Blue Medicare HMO, a select high-value network product that will offer high quality at a lower cost for seniors in 14 central and northeastern Pennsylvania counties. The product features a local network of 21 acute care hospitals and more than 4,800 physicians. A shared network in select western Pennsylvania locations will be available to members traveling across the state, including an additional 50 acute care facilities and more than 11,500 physicians. Community Blue Medicare HMO will be available in Cumberland, Dauphin, Juniata, Lackawanna, Lehigh, Luzerne, Lycoming, Northampton, Perry, Sullivan, Susquehanna, Tioga, Wayne and Wyoming counties. A map of counties and participating facilities in the Community Blue Medicare HMO service area is included below. Community Blue Medicare HMO 2016 Provider Network map Identifies: • Counties in the service area with participating facility access (dark blue) • Counties outside of the service area with participating facility access (light blue) Community Blue Medicare HMO Coming to Central and Northeastern PA continued on page 2

Transcript of Community Blue Medicare HMO · Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt...

Page 1: Community Blue Medicare HMO · Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt Effective Jan. 1, 2016, Highmark is offering Community Blue Medicare HMO, a select high-value

Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt

Effective Jan. 1, 2016, Highmark is offering Community Blue Medicare HMO, a select high-value network product that will offer high quality at a lower cost for seniors in 14 central and northeastern Pennsylvania counties.

The product features a local network of 21 acute care hospitals and more than 4,800 physicians. A shared network in select western Pennsylvania locations will be available to members traveling across the state, including an additional 50 acute care facilities and more than 11,500 physicians.

Community Blue Medicare HMO will be available in Cumberland, Dauphin, Juniata, Lackawanna, Lehigh, Luzerne, Lycoming, Northampton, Perry, Sullivan, Susquehanna, Tioga, Wayne and Wyoming counties. A map of counties and participating facilities in the Community Blue Medicare HMO service area is included below.

Community Blue Medicare HMO2016 Provider Network

map Identifies:• Counties in the service

area with participating facility access (dark blue)

• Counties outside of the service area with participating facility access (light blue)

Community Blue Medicare HMO Coming to Central and Northeastern PA continued on page 2

Page 2: Community Blue Medicare HMO · Volume 17 • Issue 11 • NoVember 2015 Newsletter Excerpt Effective Jan. 1, 2016, Highmark is offering Community Blue Medicare HMO, a select high-value

Using the Correct NAIC Code on Electronic ClaimsCommunity Blue Medicare HMO will be offered through Highmark Choice Company and will use a different NAIC code than our other Medicare Advantage product, Freedom Blue PPO. So, it’s important that the correct code is used when filing Medicare Advantage claims.• UseNAICcode54771forCommunityBlueMedicare

HMO claims.• UseNAICcode15460forFreedomBluePPOclaims.

How to Identify Community Blue Medicare HMO Members Community Blue Medicare HMO members will have the plan name in the top right corner of their member ID card. In addition to the network in central and northeastern Pennsylvania, Community Blue Medicare HMO has a shared network in western Pennsylvania.

Members with coverage based in central and northeastern Pennsylvania will have the alpha prefix KHC as part of their member ID number (see the sample ID card image). Members with coverage based in western Pennsylvania will have the alpha prefix ZPM as part of their member ID number.

Find More Information on Highmark Blue Shield’s Provider Resource CenterTo assist you in helping your patients better understand their Community Blue Medicare HMO coverage, a dedicated page is now available. The following documents are posted to the page and will appear in this order:1. Key Information for Providers2. Community Blue Medicare HMO Coming to Central

and Northeastern PA3. STARS Incentive Program and Important Reminders4. AIS Home Visit Program for Patients with Serious or

Chronic, Life-Limiting Illness5. TruHearing: An Enhanced Hearing Aid Benefit for

Highmark Members6. Part D Formulary Information7. Important Provider Service Telephone Numbers

To access this information, click on the Highmark 2016 logo under Today’s Messages on Highmark’s Provider Resource Center. Next, select 2016 Medicare Advantage Products Summary: What Providers Need to Know. Then, select Community Blue Medicare HMO Coming to Central and Northeastern PA.

Community Blue Medicare HMO Coming to Central and Northeastern PA continued from page 1

Community Blue Medicare HMO will include coverage for Medicare Part D drugs. Depending on the county, the monthly premium range is between $15 and $25. Copayments are reasonably priced at $5 for PCP office visits and $5 for select generic prescriptions. The product will also offer acupuncture and routine dental, vision and hearing benefits.Highmarkhasrevisedthehearingbenefitfor2016to significantly reduce costs to members and create a fixed copayment for hearing aids.

Likewise, it’s important for members to understand this product’s select, high-value network. We are communicating the details in many ways to members considering this product. We will also be assisting them, through a dedicated Member Service team, with finding network providers and transferring medical records.

Members who choose Community Blue Medicare HMO coverage and are in the midst of treatment with a non-participating provider may request assistance via a “transition of care” plan. Members must make this request throughMemberServicewithin60daysoftheircoverageeffective date. We will notify the member and provider in writing regarding the decision and any terms/conditions.

AlongwithCommunityBlueMedicareHMO,in2016wewillcontinue to offer Freedom Blue PPO, as well as Blue Rx, our Medicare Part D prescription drug plan.

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