Blue cross community mmai

Listed below are those insurance payers and products with which Horizon Health has direct participation agreements In Network at our Illinois locations.

Medicare Supplements fill the gaps in your Original Medicare 1. This is archive material for research purposes. Please see PDPFinder. To switch to a different Medicare Advantage plan or to change your location, click here. Although you pay no additional monthly premium, you must continue to pay your Medicare Part B premium. If you have a premium penalty, your premium will be higher. There are 41 members enrolled in this plan in Union, Illinois, and 22, members in Illinois.

Blue cross community mmai

It will open in a new window. To return to our website, simply close the new window. Refer to important information for our linking policy. The resources on this page are intended to help you navigate prior authorization requirements for Blue Cross and Blue Shield of Illinois BCBSIL government programs members enrolled in any of the following plans:. Government Programs Prior Authorization Summary and Code Lists Refer to the Summary documents below for an overview of prior authorization requirements, reminders and helpful links. Procedure code lists are provided for reference purposes. Pharmacy Benefit Prior Authorization Requirements — Prime Therapeutics, our pharmacy benefit manager, conducts all reviews of prior authorization requests from physicians for BCBSIL members with prescription drug coverage. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and their health care provider. The BCBSIL Medical Policies are for informational purposes only and are not a substitute for the independent medical judgment of health care providers. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Members should contact the customer service number on their member ID card for more specific coverage information. Availity is a trademark of Availity, LLC. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. All rights reserved. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider.

Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

If you have questions about plans and in-network status, please contact Springfield Clinic's Patient Advocate Center at Medicare Supplement XOS. This can be identified by "BCO" on the front of the card, as well as information concerning Tiered Plans on the back of the card. Please verify network status with BCBS. Refer to the chart above to determine network status. If you still have questions, the best way to determine if your plan is in-network with Springfield Clinic providers is to reach out to your insurance carrier or the human resource department of your employer. Any services that were provided prior to Jan.

It will open in a new window. To return to our website, simply close the new window. Refer to important information for our linking policy. Learn more. As a new independently contracted Blue Cross and Blue Shield of Illinois BCBSIL Medicaid provider or a new employee of a provider's office , we encourage you to take advantage of the online information and other reference material available to you. A person centered practice involves primary health care that is relationship-based with a focus on the individual. Coordination by a health care team is critical to help ensure that each member receives all services as needed, according to their health benefit plan. To help ensure the health, safety and well-being of vulnerable individuals, it is important to report critical incidents of abuse, neglect and financial exploitation to the appropriate authorities. All Rights Reserved.

Blue cross community mmai

In addition to the above appointment timeframes, providers are contractually required to ensure that provider coverage is available for members 24 hours a day, seven days a week. In addition, providers must maintain a hour answering service and ensure that each primary care physician PCP provides a hour answering arrangement, including a hour on-call PCP arrangement for all members. We routinely monitor for compliance with the above standards. Lack of compliance may lead to corrective actions, which may include corrective action plans or termination. Serious problem but not an emergency medical condition — Within one business day of the request. Initial prenatal visits without problems — Within two weeks of the date of request for a member within the first trimester, within one week in the second trimester and within three days in the third trimester. Behavioral health emergency care — Within six hours of the request. Behavioral health initial visit for routine care — Within two weeks of the date of the request. Behavioral health routine follow-up care — Within three months of the request. If you have questions regarding these requirements, contact your assigned PNC or email our Government Programs Provider Relations team.

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The best way to determine if your plan is in-network with Springfield Clinic providers is to reach out to your insurance carrier or the human resource department of your employer. Compare Discounted Medication Prices. The program is not a substitute for the independent medical judgment of a health care provider. For the most accurate and up-to-date information please contact your insurance carrier refer to your insurance membership card for contact information or human resource department to see if Springfield Clinic providers are considered in-network for your plan. The fact that a service or treatment is described in a medical policy is not a guarantee that the service or treatment is a covered benefit under a health benefit plan. Frequently Asked Questions. There are 41 members enrolled in this plan in Union, Illinois, and 22, members in Illinois. It is your responsibility to verify your insurance coverage before your visit. You are STRONGLY encouraged to obtain information on out-of-pocket expenses by calling your health plan using the toll-free telephone number on your insurance identification card. You would need to sign a waiver if you are choosing to be Self-Pay and pay out-of-pocket. Horizon Health Illinois locations have direct participation agreements with the following plans:. To switch to a different Medicare Advantage plan or to change your location, click here.

The table below contains some of the services covered under your plan.

Members should contact the customer service number on their member ID card for more specific coverage information. This plan does NOT have a deductible for the prescription drug coverage. Patients with questions on whether their plan allows this or not should reach out to BCBS in order to confirm. If you're an established patient, you can use the patient portal to communicate with your provider. Compare Discounted Medication Prices. Ask about insurance coverage for visiting specialists. How can a care coordinator help a discharge planner? If your plan is not listed, we may be out-of-network , resulting in a higher out-of-pocket expense for you as determined by your insurance carrier. Availity is a trademark of Availity, LLC. The best way to determine if your plan is in-network with Springfield Clinic providers is to reach out to your insurance carrier or the human resource department of your employer. Y es, all direct contracts will end on Jan. We accept PPO advantage plans other Medicare Advantage Plans , but may be subject to limited coverage for elective surgery and inpatient stays, which could result in greater out-of-pocket expense.