Presentation Transcript

1. Hometown Health October 2, 2013 October 2, 2013
2. State Health Network – SHBP Blue Open Access POS 17,674 Physicians 182 Hospitals BlueCard® PPO Traveling benefits outside of Georgia
3. Hometown Health in Blue Open Access POS Hometown Health hospitals participate in Blue Open Access POS All Blue Open Access POS reimbursement arrangements were negotiated prior to the SHBP award. Rates have not changed. All contracts are evergreen. Today, BCBSGa represents on average less than 5% of Hometown Health hospitals’ total patient revenue.
4. State Health Network – SHBP . In Georgia Blue Open Access POS (reimbursement) No PCP required No referrals required Out-of-network benefits Outside of Georgia BlueCard PPO for traveling benefits
5. SHBP Network Communication PlanBeing in the know. Customized communication introducing SHBP programs and resources Bi-monthly Network Bulletins will have a special section dedicated to SHBP news eBlastsas needed to deepen provider awareness of SHBP specifics Provider pages at bcbsga.com with dedicated SHBP real estate Webinarsin November for providers to learn even more Outreachas needed with providers Dedicated provider resources
6. SHBP Member ID card Network in GA: this is the reimbursement you can expect PPO “suitcase” for traveling benefits
7. SHBP Precertification Details Additional services requiring pre-certification for SHBP members include, but are not limited to: Outpatient MH/SA (13 visits and over provided by out of network providers) Nutritional / Enteral Therapy Home Health Care Home Infusion Ankle Arthroplastyand Bi-Compartmental Knee Arthroplasty Dental Services due to accident
8. Ease of doing business availity.com Multiple payers. One website. One Login. 1300+ health plans in one place 20+ Blue Cross and Blue Shield plans, commercial payers and more File claims, check eligibility, review clinical history, process payments and more Accessible 24/7 from any computer with Internet access Real-time information exchange means highest accuracy of information from health plans Simple to use. Consistent look and feel Expert client service representatives and free training Use with your existing practice management system No-cost and premium solutions fit every practice.
9. Interactive Care Reviewer (ICR) Utilizing cutting edge IBM Watson™ Technology Self - Service Provider Web tool Initiates precertification requests online more efficiently and more conveniently Allows providers to request outpatient procedures for SHBP members
10. SHBP Contact Information Dedicated Provider Customer Service: Phone: 855-641-4862 Claims or correspondence should be mailed to: Blue Cross and Blue Shield of Georgia P.O. Box 105370 Atlanta, GA 30348-5370 We appreciate your service to our members, your patients..
11. Questions
12. Appendix
13. & Provider Engagement & Contracting Locations
14. Hometown Health Provider Relations
15. Hometown Health Provider Relations
16. Hometown Health Provider Relations
17. Hometown Health Provider Relations