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

Member cost-sharing for urgent care benefit

June 29, 2012

In April, IBC introduced a new urgent care benefit designed to provide members with a lower cost alternative to emergency rooms, when appropriate. This new benefit allows members to receive services for urgent medical issues when they cannot access their physician's office but do not require the advanced medical services of an emergency department. Note: In order to be recognized as an approved IBC urgent care provider, centers must meet specific criteria (including network need) and be credentialed and contracted as an urgent care provider by IBC. Only providers who are specifically contracted and credentialed with IBC as an urgent care provider can charge an urgent care copayment. If you have any questions about the urgent care network, please call 1-800-ASK-BLUE.

Member eligibility and cost-sharing

Under the urgent care benefit, cost-sharing for commercial HMO, POS/DPOS, and PPO members varies based on their benefits plan, but generally will be about 70 percent of their ER copayment, or for coinsurance plans, the equivalent coinsurance level for ER. The cost-sharing for Medicare Advantage HMO and PPO members is their full specialist copayment for 2012. We recently enhanced our Eligibility and Benefits Inquiry transaction on the NaviNet® web portal to include copayment information for urgent care services. To view the urgent care copayment for eligible members, select Eligibility and Benefits Inquiry from the Plan Transactions menu, enter the search criteria for the member, and click Select next to the appropriate member. The urgent care copayment (if applicable) will be listed under Copays. The copayment, as well as any applicable coinsurance, will also appear on the Additional Copays screen. Please note that not all members are eligible for the urgent care benefit. As always, continue to check NaviNet for member eligibility and copayment amounts. If you have questions about viewing copayment information on NaviNet, please contact NaviNet Customer Care at 1-888-482-8057 or our eBusiness Provider Hotline at 215-640-7410. Providers without access to NaviNet must obtain eligibility and claims status information through the Provider Automated System by calling 1-800-ASK-BLUE and following the voice prompts.

NaviNet® is a registered trademark of NaviNet, Inc., an independent company.


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.