National Account members living in Colorado utilizing the Pathway network

Anthem Blue Cross and Blue Shield (Anthem) would like to provide health plan information for National Account members living in Colorado utilizing the Pathway network.  These may be both Anthem and non-Anthem National Accounts

 

“CO Pathway” Network

 

National Account members living in Colorado have a health care plan which accesses the Pathway network with an EPO/PPO plan design.  The network name on the card will indicate “CO Pathway” rather than “Pathway”, “Pathway EPO/PPO”, or “Pathway Network” as you’ve seen previously.  While the “Pathway” network name may be slightly different for these members, the network utilized is the same whether the member ID cards reference “CO Pathway”, “Pathway”, “Pathway EPO/PPO”, or “Pathway Network”.

 

When receiving care inside Colorado, National Account members must access the Pathway network for their in-network benefits.  If a National Account member chooses to receive services from an out-of-network provider, his/her out-of-network cost shares (deductible, coinsurance, out-of-pocket maximum) will apply, with the exception of emergency care. 

 

Exceptions: 

• Emergency care services will be covered as in-network benefits regardless of whether services are rendered at an in-network or out-of-network hospital as long as the service is deemed to be an emergency. 
• Preventive care services must be provided by a Pathway provider. There are no out-of-network benefits available for preventive care services. 

 

Note:  Other National Accounts may access the CO Pathway network option in the future.  Some National Accounts may allow preventive care services under out of network benefits.  Please verify eligibility and benefits prior to rendering services.

 

Eligibility and Benefit specifics can be accessed through the Availity portal at availity.com, or by contacting the Customer Service number on the back of the Member ID card.

 

PPO Suitcase logo on Member ID card

Because a National Account with members living in multiple states, these members’ benefits are administered differently than our Local Plan members.  As such, the members living in Colorado will have a PPO in the suitcase logo on their ID card.  The PPO in the suitcase means these members have access to the PPO network when traveling outside of Colorado. 

 

National Accounts utilizing the Pathway Network

• Each National Account will have its own prefix.
• The Network Name will be listed as “CO Pathway” on ID cards.

 

There are different types of National Accounts.  It may be either a Home or Host National Account:

• Home = Anthem Account;
• Host = Partner Plan account (other Blues)

 

Identifying members tied to the Pathway network

 

National Account members living in Colorado and accessing the “CO Pathway” network will have a customized three-character prefix on Member ID cards (the 3 characters at the beginning of their ID number), but the prefixes will vary by group.  The best way to identify a National Account member is by the network name being “CO Pathway”. 

 

Three-Character Prefix	Health Benefits Plan Option	Product Type	Network Name (On Member ID cards)
VAB	Individual (Exchange)	HMO	Pathway
VAC	Small Group (Exchange)	HMO	Pathway
VAA	Individual (OFF Exchange)	HMO	Pathway
QWP, XFX	Small Group (OFF Exchange)	HMO	Pathway
VAE	Large Group	HMO	Pathway Network
QAB	Federal Employee Program	HMO	Pathway Network
Varies*	National Accounts	HMO	CO Pathway
PWL, CQQ	Small Group	EPO/PPO	Pathway EPO/PPO
WUS	Large Group	EPO/PPO	Pathway EPO/PPO

*Each National Account will have its own prefix. 

 

Note:  We’ve updated our Networks at a Glance document to include the National Account information. 

 

Sample Member ID Card for National Account members accessing the “CO Pathway” network

 

(Please note the Member ID card below is just a sample, and does not include actual member information such as copays, but is included when the Member ID cards are generated and sent to members prior to the effective date.)

 

National Account -- Home Account (Anthem account) sample

 

National Account -- Host Account (Partner Plan (other Blues)) sample

 

Anthem is dedicated to providing excellent customer service for our National Account members and their providers.  If you have any additional questions, please contact the number on the back of the member ID card.

 

 

638-0920-PN-CO