As of January 1, 2014, coverage began for Keystone HMO Proactive, our new tiered network plan. As previously communicated, our HMO network providers have been categorized into one of the following three benefit tiers for Keystone HMO Proactive:Tier 1 ? Preferred: Members pay the lowest cost-sharing for most services.Tier 2 ? Enhanced: Members pay a higher cost-sharing for most services compared to Tier 1 ? Preferred.Tier 3 ? Standard: Members pay the highest cost-sharing for most services.If a Keystone HMO Proactive member presents to you for service, you will need to know your benefit tier assignment in order to determine the member?s cost-sharing (deductible, coinsurance, and/or copayments). Cost-sharing for Keystone HMO Proactive members varies based on their benefit plan (i.e., Silver or Gold) and the provider?s benefit tier assignment.Note: All physicians, hospitals, and ancillary providers from the Keystone Health Plan East HMO network are assigned a benefit tier; however, certain services have the same cost-sharing for all benefit tier levels and therefore are not affected by the benefit tier. These services include, but are not limited to, the following: mental health, laboratory, urgent care, chiropractics, and physical, occupational, and speech therapy. Provider specialties that exclusively provide services that do not have tiered benefit differentials were defaulted to the Tier 3 ? Standard benefit level.

How to determine your benefit tier assignment

Use the NaviNet^® web portal to quickly determine your benefit tier assignment. To do so, select Reference Tools from the Plan Transactions menu. Professional providers should select Network Provider Inquiry, and facility providers should select Network Facility Inquiry.Using these transactions, providers can look up their practice/facility and find their benefit tier assignment. Enter in the requested information, making sure to select Keystone HMO Proactive from the Network drop-down menu.For more instructions on how to use these transactions, refer to the user guides available in the NaviNet Transaction Changes section of the Business Transformation site.

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