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.
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