As of January 1, 2016, you may begin to see patients who are covered under Keystone 65 Focus Rx HMO (Keystone 65 Focus), a new Independence Medicare Advantage benefit product for 2016.
As a reminder, Keystone 65 Focus is a defined-network benefit product. Keystone 65 Focus members enjoy similar benefits as with broader-network Medicare Advantage HMO benefit products, while taking advantage of lower premiums and out-of-pocket costs resulting from the defined network of providers.
What you need to know
The following hospitals are participating in the Keystone 65 Focus network. Please note that if a hospital does not appear on this list, it means the hospital is not participating in the Keystone 65 Focus network. Keystone 65 Focus members should only be referred to the hospitals listed below for non-emergency services:
- Abington Health
- – Abington Memorial Hospital
- – Lansdale Hospital
Community Health Systems
- – Brandywine Hospital
- – Chestnut Hill Hospital
- – Jennersville Regional Hospital
- – Phoenixville Hospital
- – Pottstown Memorial Medical Center
Grand View Hospital
Holy Redeemer Hospital and Medical Center
Main Line Hospitals, Inc.
- – Bryn Mawr Hospital
- – Lankenau Medical Center
- – Paoli Hospital
- – Riddle Hospital
St. Luke's Health System
Thomas Jefferson University Hospital, Inc.
- – Methodist Hospital
- – Thomas Jefferson University Hospital
When treating Keystone 65 Focus members, also keep in mind the following:
- Defined provider network. Members who choose Keystone 65 Focus for their health care coverage should only be referred to providers who are participating in the Keystone 65 Focus defined network. Find Keystone 65 Focus participating providers using the online provider directory.
- Capitation for radiology and physical therapy services. Primary care physicians are not required to select capitated sites for radiology and physical therapy services for Keystone 65 Focus members. However, Keystone 65 Focus members must be issued a referral to a participating radiology or physical therapy provider in the Keystone 65 Focus network to receive these services. Reimbursement is made on a fee-for-service basis for the Keystone 65 Focus benefit product when these services are performed by a participating radiology or physical therapy provider in the Keystone 65 Focus network. Note: Capitation requirements continue to apply for laboratory services.
- Existing referrals and authorizations. You may have Independence Medicare Advantage patients who chose to enroll in Keystone 65 Focus for 2016. If those patients have referrals or authorizations on file under their former Independence Medicare Advantage plan, you may need to issue a new referral or authorization for a Keystone 65 Focus-participating provider.
For more information
Refer to the article titled Keystone 65 Focus Rx HMO, our new Medicare Advantage benefit product in the October 2015 edition of Partners in Health UpdateSM for detailed information about benefits and services covered under Keystone 65 Focus.
If you have any questions about Keystone 65 Focus, refer to the frequently asked questions on our Keystone 65 Focus Rx HMO web page. If you still have questions after reviewing this information, please contact your Network Coordinator.