Hometown Health October 2, 2013. State Health Network – SHBP Blue Open Access POS 17,674...

Hometown HealthOctober 2, 2013

October 2, 2013

State Health Network – SHBP

Blue Open Access POS17,674 Physicians

182 Hospitals

BlueCard® PPOTraveling benefits outside of

Georgia

• Hometown Health hospitals participate in Blue Open Access POS

• All Blue Open Access POS reimbursement arrangements were negotiated prior to the SHBP award. Rates have not changed.

• All contracts are evergreen.• Today, BCBSGa represents on

average less than 5% of Hometown Health hospitals’ total patient revenue.

Hometown Health in Blue Open Access POS

State Health Network – SHBP.

In Georgia • Blue Open Access POS (reimbursement)• No PCP required• No referrals required• Out-of-network benefits

Outside of Georgia• BlueCard PPO for traveling benefits

SHBP Network Communication Plan

Being in the know.Customized communication introducing SHBP programs and resources

• Bi-monthly Network Bulletins will have a special section dedicated to SHBP news

• eBlasts as needed to deepen provider awareness of SHBP specifics

• Provider pages at bcbsga.com with dedicated SHBP real estate

• Webinars in November for providers to learn even more

• Outreach as needed with providers

• Dedicated provider resources

SHBP Member ID card

Network in GA: this is the reimbursement you can expect

PPO “suitcase” for traveling benefits

SHBP Precertification DetailsAdditional services requiring pre-certification for SHBP members include, but are not limited to:

• Outpatient MH/SA (13 visits and over provided by out of network providers)

• Nutritional / Enteral Therapy• Home Health Care• Home Infusion• Ankle Arthroplasty and Bi-Compartmental

Knee Arthroplasty• Dental Services due to accident

• 1300+ health plans in one place• 20+ Blue Cross and Blue Shield plans, commercial payers and more

• File claims, check eligibility, review clinical history, process payments and more

• Accessible 24/7 from any computer with Internet access• Real-time information exchange means highest accuracy of information

from health plans• Simple to use.

• Consistent look and feel • Expert client service representatives and free training • Use with your existing practice management system

• No-cost and premium solutions fit every practice.

Ease of doing businessavaility.com

Multiple payers. One website. One Login.

Interactive Care Reviewer (ICR) Utilizing cutting edge IBM Watson™ Technology Self - Service Provider Web tool

• Initiates precertification requests online more efficiently and more conveniently

• Allows providers to request outpatient procedures for SHBP members

SHBP Contact InformationDedicated Provider Customer Service:

Phone: 855-641-4862

Claims or correspondence should be mailed to: Blue Cross and Blue Shield of GeorgiaP.O. Box 105370Atlanta, GA 30348-5370

We appreciate your service to our members, your patients..

Questions

14

Appendix

&Provider Engagement & Contracting Locations

Hospital Contractor Contact e-mail address

Network Management Consultant Contact e-mail address

Appling Hospital Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]

Archbold Memorial Hospital

Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Berrien County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Bleckley Memorial Hospital

Joseph Jay (706) 985-2549 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Brooks County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Burke Medical Center Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]

Charlton Memorial Hospital

Cheryl Holyfield (404) 842-8339 [email protected] Gregory Chatman (404) 842-8693 [email protected]

Chatuge Regional Hospital & Nursing Home

Christy Cunningham (770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]

Chestatee Regional Hospital


Clearview Regional Medical Center

Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]

Clinch Memorial Hospital


Crisp Regional Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Doctor's Hospital of Tattnall

Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]

Dodge County Hospital Joseph Jay (706) 985-2549 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Hometown Health Provider Relations

mailto:[email protected]

































East Georgia Regional Medical Center


Effingham Hospital Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]

Elbert Memorial Hospital


Emanuel Medical Center


Evans Memorial Hospital


Fairview Park Hospital Dave Chastain (404) 842-8043 [email protected] Jane O'Connor (706) 602-3057 [email protected]

Flint River Hospital Daniel Steines (706) 985-2548 [email protected] Laura Mendoza (706) 985-2264 [email protected]

Good Samaritan Christy Cunningham (770) 533-5516 [email protected] Maggie Ward (706) 985-2627 [email protected]

Grady General Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Habersham Medical Cener


Higgins General Hospital

Cheryl Holyfield (404) 842-8339 [email protected] Jackie Hrydziusko (404) 467-2676 [email protected]

Irwin County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Jeff Davis Hospital Cheryl Holyfield (404) 842-8339 [email protected] Gregory Chatman (404) 842-8693 [email protected]

Jefferson Hospital Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]





































Liberty Regional Medical Center

Cheryl Holyfield (404) 842-8339 [email protected] Gregory Chatman (404) 842-8693 [email protected]

Louis Smith Memorial Hospital


Lower Oconee Community Hospital

Joseph Jay (706) 985-2549 [email protected] Angie Thompson (706) 985-2515 [email protected]

Medical Center of Peach County

Melanie Williams (404) 848-2157 [email protected]

Angie Thompson (706) 985-2515 [email protected]

Miller County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Mitchell County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]

Monroe County Hospital Melanie Williams (404) 848-2157 [email protected]


Morgan Memorial Hospital


Mountain Lakes Medical Center

Christy Cunningham

(770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]

Murray Medical Center Angie Howard (404) 467-2937 [email protected] Jane O'Connor (706) 602-3057 [email protected]

North Georgia Medical Center

Christy Cunningham

(770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]

Northridge Medical Center


Optim Medical Center Jenkins


Pioneer - Early Memorial Hospital








































Putnam General Hospital


Toni Key (229) 432-5346 x20 [email protected]

Screven County Hospital


Smith Northview Hospital


Taylor Regional Hospital



Ty Cobb Regional Medical

Christy Cunningham (770) 533-5516 [email protected] Maggie Ward (706) 985-2627 [email protected]

Union General Hospital Christy Cunningham (770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]

Upson Regional Medical Center

Daniel Steines (706) 985-2548 [email protected] Laura Mendoza (478) 471-4521 [email protected]

Warm Springs Medical Center

Daniel Steines (706) 985-2548 [email protected] Laura Mendoza (478) 471-4521 [email protected]

Washington County Regional Medical Center


Wills Memorial Hospital Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]





























Hometown Health October 2, 2013. State Health Network – SHBP Blue Open Access POS 17,674...

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