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Identifying Preferred PCPs and the required copayments  

December 20, 2018    

As previously communicated, Independence is offering Keystone 65 Basic HMO, Keystone 65 Focus HMO-POS, Keystone 65 Preferred HMO, and Keystone 65 Select HMO individual members a new Preferred primary care physician (PCP) benefit in 2019. This new benefit will allow members to visit one of the hundreds of Preferred PCPs in our network and pay nothing out of pocket.

Our Medicare Advantage HMO and HMO-POS network PCPs have been categorized into one of two benefit tiers:

  • Preferred. Members will pay $0 cost-sharing for PCP visits.
  • Standard. Members will pay the same cost-sharing for PCP visits as 2018.

Note: Capitation payments are higher for members who have $0 copay to compensate PCPs for what they would have collected with higher copays.

Independence sent letters to practices identified as Preferred PCPs to notify them of the distinction. This article walks through how your practice will appear in the Find a Doctor tool, and how to identify the required copayments on the NaviNet® web portal.

Preferred PCP designation

Our Find a Doctor tool for Medicare Advantage members has been updated to include your practice’s tier. Simply type your name in the search field next to All Categories and hit the magnifying glass to begin the search. Below is an example of how a Preferred PCP will appear.

In addition, the following message appears at the top of the page to remind you that Independence individual Medicare Advantage HMO members have a $0 copayment:

Identifying copayments using NaviNet

If a member has chosen the new Preferred PCP benefit, the NaviNet Eligibility and Benefits Inquiry transaction will return one of the two new informational messages on the Eligibility & Benefits Detail screen advising you of the member’s PCP benefit tier.

You can also view the PCP copay amount by selecting Additional Benefit Provisions link from the right-hand side of the screen and then select Professional Services from the prompt.  

More information

We have updated the Eligibility and Benefits Inquiry Guide to include this new information, which can be found in the NaviNet Resources section. If you have additional questions on the Eligibility and Benefits Inquiry transaction, please call the eBusiness Hotline at 215-640-7410.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

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