AdministrativeCommercialDecember 31, 2019

New Pathway PPO network to support new product offerings available January 1, 2020

We would like to educate you on a new network to support new product offerings available starting this year.  Our network called “Pathway”, previously a subset of our standard HMO network only, is now going to be available as a PPO network option for certain PPO/EPO plan offerings effective 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.

  • 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.