Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Reminder: Benefit tier re-evaluation for Keystone HMO Proactive

August 28, 2014

[

In 2014, IBC introduced Keystone HMO Proactive, a lower-cost, tiered provider network product available both on and off the Health Insurance Marketplace. For this product, providers in IBC's HMO network were categorized into one of three benefit tiers:

  • Tier 1 ? Preferred: Members pay the lowest cost-sharing for most services.
  • Tier 2 ? Enhanced: Members pay a higher cost-sharing for most services compared to Tier 1 ? Preferred.
  • Tier 3 ? Standard: Members pay the highest cost-sharing for most services.

Re-evaluation of benefit tier placements for 2015

As previously communicated, IBC reviews provider benefit tier placements annually for Keystone HMO Proactive. We recently concluded our re-evaluation of benefit tier placements for our facility, ancillary, and professional providers for 2015.

Only providers whose benefit tier will change will be mailed a letter in the coming weeks with their new benefit tier assignment. The new benefit tier will remain in place from January 1, 2015, through December 31, 2015.

Note: If you do not receive a letter regarding your benefit tier placement by the end of September, then your benefit tier is not changing for 2015.

Benefit tier placement criteria for professional providers

Like last year, benefit tier placement for professional providers is based upon criteria that include relative cost (i.e., contracted fee schedule), minimum quality standards (if applicable), and the tier of the facilities to which a provider's IBC patients are typically referred for hospital and outpatient surgical services.

Questions

If you have questions specific to Keystone HMO Proactive or your benefit tier placement, please contact your Network Coordinator.

]

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.