As previously communicated, the Patient Protection and Affordable Care Act, also known as Health Care Reform, mandates a three-month grace period for individual members who receive a premium subsidy from the government and are delinquent in paying their portion of the premiums.

Under this mandate, insurers are required to pay medical claims received during the first 30 days of the grace period, but may pend medical claims for services rendered to those members and their eligible dependents during the second and third months of the grace period. Insurers are also required to notify affected providers when one of these members enters the grace period. If payment is not received by the end of the grace period, the pended claims will be denied and the member?s policy will be terminated.

To comply with the mandate, IBC will notify affected providers by mail upon receipt of a claim for services rendered for a member who is within the second or third month of the grace period. In addition, a new field called APTC (Advanced Premium Tax Credit) is available within the Eligibility and Benefits Inquiry transaction on the NaviNet^® web portal to show providers when a member is in the grace period and provide a status of the member?s claims. The APTC field will only display when a member is in a delinquency status. When the member enters the grace period, the APTC field will be populated on the Eligibility and Benefits Details screen (as shown below) with the word "Yes." There will be a corresponding message that indicates the month of delinquency the member is in and the status of his or her claims. If payment is not received before the grace period expires, the member?s policy will be terminated.

If you have any questions about this mandate, please call Customer Service at 1-800-ASK-BLUE (1-800-275-2583). If you have questions regarding NaviNet transactions, please call the eBusiness Hotline at 215-640-7410.