Updates to the Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Preauthorization Lists (2024)

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Recap of Options Offered During the 2016 Open Enrollment Period

February23,2016

January 31 marked the end of the third annual enrollment period through the Health Insurance Marketplace. Blue Cross and Blue Shield of Texas (BCBSTX) remained committed to providing all Texans with sustainable health plan options that meet the varying needs of the state's population and contribute to the state's overall health. BCBSTX offers health insurance in all 254 counties in Texas and is the only health insurance provider offering individuals access to health insurance through the Federal Health Insurance marketplace in 58 of those counties.

2016 Individual Network Options
Individual members are those who buy their own insurance that is not provided by an employer or through a government program (Medicare, Medicaid, or CHIP). The following options were offered to individual members:

• BCBSTX offered its Blue Advantage (BAV) HMO^SM again to individual members both on and off the Health Insurance Marketplace.
• BCBSTX offered the new Blue Advantage Plus^SM HMO plan with added Point of Service (POS) benefits to individual members both on and off the Health Insurance Marketplace. This new HMO utilizes the Blue Advantage HMO network of doctors and hospitals while still having out-of-network benefits.
• BCBSTX also offered Blue Cross Blue Shield Premier 101^SM, a multi-state plan that utilizes the Blue Advantage HMO network; and has the same preauthorization requirements as Blue Advantage HMO. Blue Cross Blue Shield Premier 101 is only available to Individual members on the Health Insurance Marketplace.
  Please Note: Multi-State Plans are designed to increase consumer options on the exchanges. They are only available in the Individual market segment, through the Public Exchange. Multi-State Plans are bound by the same ACA regulations as other Qualified Health Plans, i.e., Essential Health Benefits, Out of Pocket Maximum regulations, etc.

Small Business Health Options Program (SHOP) Options
BCBSTX will continue to offer the Blue Choice PPO to small group members on the Small Business Health Options Program (SHOP). Small Group members will also still have access to our Blue Advantage HMO product. As a reminder, the terms of your BCBSTX agreements apply to plans offered on and off the SHOP. The terms of the agreement also require providers to offer their services to a BCBSTX member, regardless of where they purchased their coverage.

Identifying Your Patients' BCBSTX Insurance Plan
To identify your patient's BCBSTX plan, please view our sample ID cards. Plan specific alpha prefixes are assigned to every Blue Cross Blue Shield (BCBS) plan and start with X, Y, Z or Q. The first two positions indicate the BCBS Plan to which the member/subscriber belongs, while the third position identifies the product in which the member/subscriber is enrolled. Note: ZG identifies the Texas Plan.

• To identify a patient who has the BAV HMO plan look for the alpha prefix or Texas alpha prefix which will start with “ZG*”" on the member ID card. The first two positions indicate the Plan to which the member/subscriber belongs while the third position identifies the product in which the member/subscriber is enrolled.
• To identify a patient who has the BAV Plus, look for alpha prefix "ZGN" on the member ID card.
• To identify a patient who has the 'Blue Cross Blue Shield Premier 101' multi-state plan (not specific to Texas), look for alpha prefix "VAL" on the member ID card.

Resources to Provide to your Patient's with Questions
If you have patients that are seeking assistance with their transition of care, we encourage you and your patients to contact BCBSTX with your questions through the phone numbers below. Our member advocates will work closely with your patients to ensure they have someone to speak with directly regarding their transition of care plan.

Member Customer Service: 888-697-0683
Pre-Authorization: 855-462-1785
Behavioral Health: 800-729-2422

BCBSTX provides a wide range of services and online tools to help renewing members make informed health decisions.

• Provider Finder^®: Members can select the best network provider for their needs based on location, as well as view industry-respected third party quality indicators, costs and patient-submitted reviews on an easy-to-navigate website.
• Blue Access for Members^SM: Members can access information on their policy, including status of claims, alerts, temporary ID cards and more. This also includes Blue Access Mobile^SM, which allows members to find a doctor, hospital or urgent care facility in addition to benefit information.
• 24/7 Nurseline: Members can speak with registered nurses about health concerns, common health information and tips and advice on where to go to receive necessary care.

You can also contact your local network management representative with any questions you may have.