BLUECONNECT

Providers

September 2023

In This Issue

►

September news: Executive summary

►

Commercial plans transition to MCG care guidelines

►

We're streamlining our 2024 HMO product options

►

Secondary code edits implementing in November

►

Learn + earn credits: Lifestyle medicine and nutrition

Take our Stigma-Free AZ pledge

New for 2024: Redesigned HMO options

We’re streamlining our HMO product options for 2024 to better serve our Blue Cross^® Blue Shield^® of Arizona (AZ Blue) members and make things simpler for you. Here’s a quick summary of our plan:

1. Expand the number of "open-access" HMO plan options

All of our 2023 PCP Coordinated Care HMO (PCP-HMO) plans will become open-access HMO plans that do not require PCP referrals. This includes the current PCP-HMO plans that use the Neighborhood, Alliance, MaricopaFocus, PimaConnect, PimaFocus, and Statewide HMO networks. Although we will continue to recommend strong PCP-patient relationships, members will have the option to see specialists without a referral.

2. Offer just one PCP-HMO plan (for individuals/families only) and pair it with the new “ACA Health Choice” network

This new PCP-HMO benefit plan, named “ACA StandardHealth with Health Choice” (prefix IAZ), will be administered by our affiliated Health Choice organization. You’ll be in-network for the plan if you’re participating in the new ACA Health Choice network.

Note: The plan will require a PCP referral for most specialist visits and the referral information must be included on the claim in order for the service to be covered.

Provider assistance and online tools/resources will be available through the Health Choice provider assistance team (1-800-322-8670) and the Health Choice provider portal. The Health Choice team will support you with inquiries related to eligibility verification, benefits, prior authorization requirements and requests, claim submission (use EDI RP105 for this plan), claim status, remits, and appeals and grievances.

3. Consolidate the Medicare Advantage HMO networks

The BluePathway^SM HMO networks will merge with the Blue Advantage network. The expanded Blue Advantage network will serve all of our Medicare Advantage (MA) HMO plans across Maricopa, Pinal, and Pima counties. Providers will have one participation agreement and a single point of contact for most transactions. The prefix for all of the 2024 MA HMO plans will be M2K.

2024 HMO plans at a glance

The table below summarizes our 2024 HMO changes across all lines of business.

Please share this information with your administrative and clinical support teams. If you have questions about our HMO plans for 2024, you can call us at 602-864-4320 or 1-800-232-2345, ext. 4320, or contact your provider liaison.