HomeAdministrativeBilling & ReimbursementBlueCardHealth and WellnessMedicalNaviNet OpenPEAR portalPharmacyProductsQuality Management


Member benefit changes and clarifications for commercial members 

October 31, 2014    

Effective January 1, 2015, unless otherwise noted, the following member benefits changes and clarifications will be implemented for several commercial programs for Pennsylvania members:

Type of benefit/service Plans affected Change/clarification
Precertification for BlueCard® providers effective July 1, 2014 POS – Self-referred only DPOS – Self-referred only PPO – All Language is being revised to indicate that BlueCard providers are now responsible for obtaining precertification for inpatient admissions. However, for all other covered services received from BlueCard providers, members will still be responsible for obtaining precertification, if required. In addition, members continue to be responsible for obtaining precertification for all services that require precertification if they use a non-participating provider.
Subrogation HMO – All POS – All DPOS – All PPO – All Major Medical – All Hospitalization – All Freestanding Vision and Rx – All Language is being updated to allow Independence to better enforce its subrogation rights and obtain reimbursement for its costs when a third party is involved.
After-hours/home visits – PCP copayment HMO – Non-Flex only POS – Non-Flex only Language indicating separate copayments for after-hours visits and home visits has been removed from the benefits booklet and the schedule of covered services. The primary care physician (PCP) office visit copayment will apply for these services.

Please call Customer Service at 1-800-ASK-BLUE with any questions.

Connect with us    Facebook     Twitter     Flickr     YouTube    Walk the Talk   Independence Pinterest   Independence Google+   Independence LinkedIn   Independence InstagramSite Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2020 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.