CommercialDecember 31, 2019
New Pathway PPO network to support new product offerings available January 1, 2020
The Pathway PPO network will be the same as our Pathway HMO network, but will now be available for PPO plan offering options. Those providers already participating in our Pathway HMO Network, have been invited to participate in our Pathway PPO Network unless they have chosen to opt out.
The reimbursement rates for the Pathway PPO network will be the same as your Pathway HMO reimbursement rates.
Please note: Since the Anthem Rates are the same for both Pathway HMO and Pathway PPO, participation for the Pathway PPO network is required to remain in the Pathway HMO network. We are not able to accommodate participation in Pathway HMO only.
Important distinction for Pathway PPO plan options:
- Members will have access to the Pathway network when rendering services inside Colorado.
- No out-of-network benefits inside Colorado unless Emergency.
- No out-of-network benefits inside Colorado unless Emergency.
- Members will have access to the PPO network ONLY when rendering services outside of Colorado.
Identifying Members accessing the Pathway Network:
Network Name (On Member ID cards) |
Product Type |
Health Benefits Plan Option |
Three-Character Prefix |
Pathway X |
HMO |
Individual (Exchange) |
VAB |
Pathway X |
HMO |
Small Group (Exchange) |
VAC |
Pathway |
HMO |
Individual (Off Exchange) |
VAA |
Pathway |
HMO |
Small Group (Off Exchange) |
XFX |
Pathway |
HMO |
National Accounts |
QWP |
Pathway Network |
HMO |
Large Group |
VAE |
Pathway PPO |
PPO |
Small Group |
PWL, CQQ |
Pathway PPO |
PPO |
Large Group |
WUS |
Note: While the “Pathway” network name may be slightly different depending on the Health Benefit Plan option, the network utilized for these on and off Exchange plans is the same.
Pathway PPO sample Member ID card
Small Group sample
Large Group sample
Provider Webinar opportunities discussing Pathway PPO Network
We will be conducting a “Working with Anthem” webinar regarding a Pathway PPO Overview on January 29, 2020 at 12pm MT. Please join us to learn about our new Pathway PPO network and the new products available to access this network starting January 1, 2020. Requirements for attending an online webinar include: access to a computer with internet access, phone, and email address.
Webinar Registration link: go to anthem.com, and select Provider. Under the Communications heading, select Education an Training. (Select Colorado, if you have not done so already). Under the Seminars and Webinars heading, select the plus sign next to Working with Anthem webinars, then Register for a Working with Anthem Webinar.
Thank you for the care you provide to our members.
ATTACHMENTS: Pathway PPO sample ID card - Small Group.jpg (jpg - 0.04mb), Pathway PPO sample ID card - Large Group.jpg (jpg - 0.16mb)
PUBLICATIONS: January 2020 Anthem Provider News and Important Updates - Colorado
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