Please note: The special
accommodations noted below that were required as part of the President?s
emergency declaration expired on February 20, 2014. This page has been retained
for archival purposes only.
Due to the emergency declared in parts of Pennsylvania (Bucks, Chester,
Delaware, Lancaster, Montgomery, Philadelphia, and York counties), the Centers
for Medicare & Medicaid Services requires that special accommodations be made
to allow for greater access to care for Medicare Advantage members that reside
in these counties.
Please note the following temporary policies:
Referrals. We understand that there may be extenuating circumstances that
hinder your patients from receiving a referral from their primary care
physician (PCP); therefore, we will pay claims for services where the member
was unable to obtain a referral for all Medicare Advantage HMO/POS members
until further notice.
Capitated Services. If a Medicare Advantage HMO/POS member presents for
capitated services (laboratory, radiology, physical therapy) and you are not
the designated site, please provide service to these members. We encourage you
to request authorization through the Care Management and Coordination
department by calling 1-800-ASK-BLUE (1-800-275-2583); however, it is not a
requirement until further notice.
We will provide additional information and updates regarding these temporary
policies. We appreciate your support as we work together to ensure that our
members have access to the services they need during this time.