Independence offers Keystone HMO Proactive, a lower-cost, tiered provider
network product available both on and off the Health Insurance Marketplace. For
this product, providers in Independence's commercial HMO network are
categorized into one of three benefit tiers:
- 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.
Re-evaluation of benefit tier placements for
2020
Independence reviews provider benefit tier placements annually for Keystone
HMO Proactive. As such, we recently concluded our re-evaluation of benefit tier
placements for our facility, ancillary, and professional providers for 2020.
Providers whose benefit tier is changing should have received a letter
indicating their new benefit tier assignment. The new benefit tier will remain
in place from January 1, 2020, through December 31, 2020. If you do not receive
a letter regarding your benefit tier placement, then your benefit tier is not
changing for 2020.
Benefit tier placement criteria for
professional providers
Like last year, benefit tier placement for professional providers is based
upon criteria that include relative cost (i.e., contracted fee schedule),
minimum quality standards (if applicable), and the tier of the facilities to
which a provider's Independence patients are typically referred for hospital
and outpatient surgical services.
Questions
If you have questions specific to Keystone HMO Proactive or your benefit
tier placement, please contact the Provider Network Services team at pnsproviderrequests@ibx.com.