Transcript Hometown Health_v 2 new

Hometown Health
October 2, 2013
October 2, 2013
State Health Network – SHBP
Blue Open Access POS
17,674 Physicians
182 Hospitals
BlueCard® PPO
Traveling benefits outside of
Georgia
Hometown Health in
Blue Open Access POS
• 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.
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
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
7
SHBP Member ID card
Network in GA: this is
the reimbursement you
can expect
PPO “suitcase” for traveling benefits
SHBP Precertification Details
Additional services requiring precertification 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
Ease of doing business
availity.com
Multiple payers. One website. One Login.
• 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.
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
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..
Questions
Appendix
14
&
Provider Engagement &
Contracting Locations
Hometown Health Provider Relations
Hospital
Contractor
Contact
e-mail address
Network
Management
Consultant
Contact
Appling Hospital
Nicole Early
(404) 842-8350
[email protected]
Gregory Chatman
(404) 842-8693
Archbold Memorial
Hospital
Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Berrien County Hospital Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Bleckley Memorial
Hospital
Joseph Jay
(706) 985-2549
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Brooks County Hospital Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Burke Medical Center
Debra Smalley
(706) 228-3918
[email protected] Julie Hullum
(706) 228-3912
[email protected]
Charlton Memorial
Hospital
Cheryl Holyfield
(404) 842-8339
[email protected] Gregory Chatman
(404) 842-8693
gregory.chatman@wellpoint
.com
Chatuge Regional
Hospital & Nursing
Home
Chestatee Regional
Hospital
Christy Cunningham
(770) 533-5516
[email protected]
Renee Mason
(770) 533-5524
[email protected]
Christy Cunningham
(770) 533-5516
[email protected]
Renee Mason
(770) 533-5524
[email protected]
Clearview Regional
Medical Center
Debra Smalley
(706) 228-3918
[email protected] Julie Hullum
(706) 228-3912
[email protected]
Clinch Memorial
Hospital
Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Crisp Regional Hospital Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Doctor's Hospital of
Tattnall
Nicole Early
(404) 842-8350
[email protected]
Gregory Chatman
(404) 842-8693
Dodge County Hospital Joseph Jay
(706) 985-2549
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
e-mail address
gregory.chatman@wellpoint
.com
gregory.chatman@wellpoint
.com
Hometown Health Provider Relations
Hospital
Contractor
Network
Management
Consultant
Contact
Contact
e-mail address
East Georgia Regional Debra Smalley
Medical Center
(404) 848-2303
[email protected] Julie Hullum
(706) 228-3912
[email protected]
Effingham Hospital
Nicole Early
(404) 842-8350
[email protected]
(404) 842-8693
Elbert Memorial
Hospital
Debra Smalley
(706) 228-3918
[email protected] Julie Hullum
(706) 228-3912
gregory.chatman@wellpoint
.com
[email protected]
Emanuel Medical
Center
Debra Smalley
(706) 228-3918
[email protected] Julie Hullum
(706) 228-3912
[email protected]
Evans Memorial
Hospital
Nicole Early
(404) 842-8350
[email protected]
(404) 842-8693
gregory.chatman@wellpoint
.com
Fairview Park Hospital
Dave Chastain
(404) 842-8043
[email protected] Jane O'Connor
(706) 602-3057
[email protected]
Flint River Hospital
Daniel Steines
(706) 985-2548
[email protected]
Laura Mendoza
(706) 985-2264
[email protected]
m
Good Samaritan
Christy Cunningham
(770) 533-5516
[email protected]
Maggie Ward
(706) 985-2627
[email protected]
Grady General Hospital Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Habersham Medical
Cener
Christy Cunningham
(770) 533-5516
[email protected]
Renee Mason
(770) 533-5524
[email protected]
Higgins General
Hospital
Cheryl Holyfield
(404) 842-8339
[email protected] Jackie Hrydziusko
(404) 467-2676
jackie.hrydziusko@wellpoint
.com
Irwin County Hospital
Debra Gee
(706) 985-2037
[email protected]
(229) 432-5346 x20 [email protected]
Jeff Davis Hospital
Cheryl Holyfield
(404) 842-8339
[email protected] Gregory Chatman
(404) 842-8693
gregory.chatman@wellpoint
.com
Jefferson Hospital
Debra Smalley
(706) 228-3918
[email protected] Julie Hullum
(706) 228-3912
[email protected]
Gregory Chatman
Gregory Chatman
Toni Key
e-mail address
Hometown Health Provider Relations
Network
Management
Consultant
Contact
Hospital
Contractor Contact
e-mail address
Liberty Regional
Medical Center
Cheryl Holyfield
(404) 842-8339
[email protected] Gregory Chatman
(404) 842-8693
Louis Smith Memorial
Hospital
Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Lower Oconee
Community Hospital
Joseph Jay
(706) 985-2549
[email protected]
Angie Thompson
(706) 985-2515
angie.thompson@wellpoint.
com
Medical Center of
Peach County
Melanie Williams
(404) 848-2157
[email protected] Angie Thompson
om
(706) 985-2515
angie.thompson@wellpoint.
com
Miller County Hospital
Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Mitchell County Hospital Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Monroe County Hospital Melanie Williams
(404) 848-2157
[email protected] Angie Thompson
om
(706) 985-2515
angie.thompson@wellpoint.
com
Morgan Memorial
Hospital
(706) 228-3918
[email protected] Julie Hullum
(706) 228-3912
[email protected]
Mountain Lakes Medical Christy
Center
Cunningham
(770) 533-5516
[email protected] Renee Mason
(770) 533-5524
[email protected]
Murray Medical Center Angie Howard
(404) 467-2937
[email protected] Jane O'Connor
(706) 602-3057
[email protected]
North Georgia Medical Christy
Center
Cunningham
(770) 533-5516
[email protected] Renee Mason
(770) 533-5524
[email protected]
Northridge Medical
Center
Debra Smalley
(706) 228-3918
[email protected] Julie Hullum
(706) 228-3912
[email protected]
Optim Medical Center
Jenkins
Nicole Early
(404) 842-8350
[email protected]
Gregory Chatman
(404) 842-8693
gregory.chatman@wellpoin
t.com
Pioneer - Early
Memorial Hospital
Debra Gee
(706) 985-2037
[email protected]
Toni Key
(229) 432-5346 x20 [email protected]
Debra Smalley
e-mail address
gregory.chatman@wellpoin
t.com
Hometown Health Provider Relations
e-mail address
Network
Management
Consultant
Contact
Hospital
Contractor
Contact
Putnam General
Hospital
Melanie Williams
(404) 848-2157 [email protected] Toni Key
m
(229) 432-5346 x20
e-mail address
[email protected]
Screven County
Hospital
Nicole Early
(404) 842-8350 [email protected]
Gregory Chatman
(404) 842-8693
gregory.chatman@wellpoi
nt.com
Smith Northview
Hospital
Debra Gee
(706) 985-2037 [email protected]
Toni Key
(229) 432-5346 x20
[email protected]
Taylor Regional
Hospital
Melanie Williams
(404) 848-2157 [email protected] Angie Thompson
m
(706) 985-2515
angie.thompson@wellpoi
nt.com
Ty Cobb Regional
Medical
Christy Cunningham
(770) 533-5516 [email protected]
Maggie Ward
(706) 985-2627
[email protected]
m
Union General Hospital Christy Cunningham
(770) 533-5516 [email protected]
Renee Mason
(770) 533-5524
[email protected]
Upson Regional
Medical Center
Daniel Steines
(706) 985-2548 [email protected]
Laura Mendoza
(478) 471-4521
[email protected]
om
Warm Springs Medical Daniel Steines
Center
(706) 985-2548 [email protected]
Laura Mendoza
(478) 471-4521
[email protected]
om
Washington County
Debra Smalley
Regional Medical
Center
Wills Memorial Hospital Debra Smalley
(706) 228-3918 [email protected]
Julie Hullum
(706) 228-3912
[email protected]
(706) 228-3918 [email protected]
Julie Hullum
(706) 228-3912
[email protected]