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Hometown Health October 2, 2013. State Health Network – SHBP Blue Open Access POS 17,674 Physicians 182 Hospitals BlueCard® PPO Traveling benefits outside.

Published byHarvey Lawrence Modified over 8 years ago

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Presentation on theme: "Hometown Health October 2, 2013. State Health Network – SHBP Blue Open Access POS 17,674 Physicians 182 Hospitals BlueCard® PPO Traveling benefits outside."— Presentation transcript:

1 Hometown Health 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 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. Hometown Health in Blue Open Access POS

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 Plan Being in the know. Customized communication introducing SHBP programs and resources Bi-monthly Network Bulletins will have a special section dedicated to SHBP news eBlasts as needed to deepen provider awareness of SHBP specifics Provider pages at bcbsga.com with dedicated SHBP real estate Webinars in November for providers to learn even more Outreach as needed with providers Dedicated provider resources

6 6

7 7

8 SHBP Member ID card Network in GA: this is the reimbursement you can expect PPO “suitcase” for traveling benefits

9 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 Arthroplasty and Bi-Compartmental Knee Arthroplasty Dental Services due to accident

10 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. Ease of doing business availity.com Multiple payers. One website. One Login.

11 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

12 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..

13 Questions

14 14 Appendix

15 & Provider Engagement & Contracting Locations

16 HospitalContractorContacte-mail address Network Management ConsultantContacte-mail address Appling HospitalNicole Early(404) 842-8350nicole.early@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoint.com Archbold Memorial Hospital Debra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Berrien County HospitalDebra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Bleckley Memorial Hospital Joseph Jay(706) 985-2549jjay@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Brooks County HospitalDebra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Burke Medical CenterDebra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Charlton Memorial Hospital Cheryl Holyfield(404) 842-8339cheryl.holyfield@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoint.com Chatuge Regional Hospital & Nursing Home Christy Cunningham(770) 533-5516ccunningham@bcbsga.comRenee Mason(770) 533-5524rrmason@bcbsga.com Chestatee Regional Hospital Christy Cunningham(770) 533-5516ccunningham@bcbsga.comRenee Mason(770) 533-5524rrmason@bcbsga.com Clearview Regional Medical Center Debra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Clinch Memorial Hospital Debra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Crisp Regional HospitalDebra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Doctor's Hospital of Tattnall Nicole Early(404) 842-8350nicole.early@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoint.com Dodge County HospitalJoseph Jay(706) 985-2549jjay@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Hometown Health Provider Relations

17 HospitalContractorContacte-mail address Network Management ConsultantContacte-mail address East Georgia Regional Medical Center Debra Smalley(404) 848-2303debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Effingham HospitalNicole Early(404) 842-8350nicole.early@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoint.com Elbert Memorial Hospital Debra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Emanuel Medical Center Debra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Evans Memorial Hospital Nicole Early(404) 842-8350nicole.early@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoint.com Fairview Park HospitalDave Chastain(404) 842-8043david.chastain@bcbsga.comJane O'Connor(706) 602-3057jane.oconnor@bcbsga.com Flint River HospitalDaniel Steines(706) 985-2548dsteines@bcbsga.comLaura Mendoza(706) 985-2264laura.mendoza@bcbsga.co m Good SamaritanChristy Cunningham(770) 533-5516ccunningham@bcbsga.comMaggie Ward(706) 985-2627maggie.ward@bcbsga.com Grady General HospitalDebra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Habersham Medical Cener Christy Cunningham(770) 533-5516ccunningham@bcbsga.comRenee Mason(770) 533-5524rrmason@bcbsga.com Higgins General Hospital Cheryl Holyfield(404) 842-8339cheryl.holyfield@bcbsga.comJackie Hrydziusko(404) 467-2676jackie.hrydziusko@wellpoint.com Irwin County HospitalDebra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Jeff Davis HospitalCheryl Holyfield(404) 842-8339cheryl.holyfield@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoint.com Jefferson HospitalDebra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Hometown Health Provider Relations

18 HospitalContractorContacte-mail address Network Management ConsultantContacte-mail address Liberty Regional Medical Center Cheryl Holyfield(404) 842-8339cheryl.holyfield@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoin t.com Louis Smith Memorial Hospital Debra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Lower Oconee Community Hospital Joseph Jay(706) 985-2549jjay@bcbsga.comAngie Thompson(706) 985-2515angie.thompson@wellpoint. com Medical Center of Peach County Melanie Williams(404) 848-2157melanie.williams@wellpoint.c om Angie Thompson(706) 985-2515angie.thompson@wellpoint. com Miller County HospitalDebra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Mitchell County HospitalDebra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Monroe County HospitalMelanie Williams(404) 848-2157melanie.williams@wellpoint.c om Angie Thompson(706) 985-2515angie.thompson@wellpoint. com Morgan Memorial Hospital Debra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Mountain Lakes Medical Center Christy Cunningham (770) 533-5516ccunningham@bcbsga.comRenee Mason(770) 533-5524rrmason@bcbsga.com Murray Medical CenterAngie Howard(404) 467-2937angie.howard@wellpoint.comJane O'Connor(706) 602-3057jane.oconnor@bcbsga.com North Georgia Medical Center Christy Cunningham (770) 533-5516ccunningham@bcbsga.comRenee Mason(770) 533-5524rrmason@bcbsga.com Northridge Medical Center Debra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Optim Medical Center Jenkins Nicole Early(404) 842-8350nicole.early@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoin t.com Pioneer - Early Memorial Hospital Debra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Hometown Health Provider Relations

19 HospitalContractorContacte-mail address Network Management ConsultantContacte-mail address Putnam General Hospital Melanie Williams(404) 848-2157melanie.williams@wellpoint.co m Toni Key(229) 432-5346 x20toni.key@bcbsga.com Screven County Hospital Nicole Early(404) 842-8350nicole.early@bcbsga.comGregory Chatman(404) 842-8693gregory.chatman@wellpoi nt.com Smith Northview Hospital Debra Gee(706) 985-2037debra.gee@bcbsga.comToni Key(229) 432-5346 x20toni.key@bcbsga.com Taylor Regional Hospital Melanie Williams(404) 848-2157melanie.williams@wellpoint.co m Angie Thompson(706) 985-2515angie.thompson@wellpoi nt.com Ty Cobb Regional Medical Christy Cunningham(770) 533-5516ccunningham@bcbsga.comMaggie Ward(706) 985-2627maggie.ward@bcbsga.co m Union General HospitalChristy Cunningham(770) 533-5516ccunningham@bcbsga.comRenee Mason(770) 533-5524rrmason@bcbsga.com Upson Regional Medical Center Daniel Steines(706) 985-2548dsteines@bcbsga.comLaura Mendoza(478) 471-4521laura.mendoza@bcbsga.c om Warm Springs Medical Center Daniel Steines(706) 985-2548dsteines@bcbsga.comLaura Mendoza(478) 471-4521laura.mendoza@bcbsga.c om Washington County Regional Medical Center Debra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Wills Memorial HospitalDebra Smalley(706) 228-3918debra.smalley@bcbsga.comJulie Hullum(706) 228-3912julie.hullum@bcbsga.com Hometown Health Provider Relations

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