We previously advised that Anthem was selected as the sole medical carrier for the State of Connecticut Employer Group and the Connecticut Partnership Plan effective October 1, 2020. In addition, we advised that both would be implementing several changes to their health plan coverage through Anthem in 2020.

 

A summary of those changes is as follows:

  • State of Connecticut employees have a new plan choice – the State BlueCare Prime Plus Point of Service (POS) plan which lets them  save on premiums when receiving care only from high-quality doctors, specialists and locations in the new State BlueCare Prime network. Note that referrals for specialist care are required as referenced in article titled ‘BlueCare Prime gate keeper plans referral process’, also published in the September 2020 issue of Provider News.   
    • The State BlueCare POE, State BlueCare POE Plus*, State BlueCare POS, State Preferred PPO and State Out-of-Area health plans continue to be available.
    • Referrals for specialist care are also required for the POE Plus plan for professional providers only. Providers will continue to use the PCP’s NPI in Box 17A on the CMS 1500 claim form.
  • The State has identified high-quality doctors, hospitals and medical groups for common, full episodes-of-care medical procedures as part of its new Networks of Distinction program in which providers meeting certain care delivery performance standards are designated as “Networks of Distinction providers.” This is available to both State of Connecticut and Connecticut Partnership health plan members who may also be eligible for travel reimbursement and cash incentives for choosing these providers and care locations. Some of the services under this program include bariatric surgery, cardiac procedures, colonoscopies and hip, shoulder and knee surgery. 
  • The State is introducing the Health Navigator program to make it easier for employees to find quality care and navigate the health care system. ‘Health Navigators’ will be central points of contact to help simplify members’ health care experience and connect them to the right care particularly around the Networks of Distinction program. Health Navigators will help schedule appointments on behalf of members and will facilitate travel reimbursement and incentive payments for episodes of care events. Their support will complement and be highly coordinated with support offered through Anthem’s State of Connecticut Enhanced Dedicated Member Services team. 
  • Employees enrolled in these health plans will receive new medical ID cards in the mail that apply for BOTH medical and pharmacy benefits (example shown below). All State of Connecticut and Connecticut Partnership Plan members will be assigned a new member ID and group ID numbers. You should ensure your patients covered under these plans provide their new ID card information – which they can email to your office using Anthem’s new Sydney Health mobile app – for any services provided on or after October 1, 2020 to help avoid claims processing delays. 
  • Employees covered under the State of Connecticut and Connecticut Partnership health plans will continue to have 100% coverage ($0 copay) for lab tests, X-rays and high-cost imaging services, like MRIs, when they select network providers designated as Site of Service under their plan. These are high-quality, low-cost participating providers for these types of services.

 

Sample State of Connecticut Member ID Card

    

 

For your convenience, we’ve included a list of State of Connecticut Employer group and State Partnership Plan member ID number alpha prefixes below.

 

State of Connecticut Employer Group and State Partnership Plan Member ID Number Prefix List

 

 

Network  Name

Product Type

State of Connecticut

State Partnership Plan

State Preferred

PPO

XGS

N/A

State BlueCare

HMO - Point of Service (PCP referral not required)

XGR

SHP

State BlueCare

HMO - Point of Enrollment (PCP referral not required)

XGT

N/A

State BlueCare

HMO - Point of Enrollment (PCP referral required)

XGL

N/A

State BlueCare Prime (Narrow Network)

HMO (PCP referral required)

NOT A TIERED PLAN

X6G

N/A


645-0920-PN-CT



Featured In:
September 2020 Anthem Connecticut Provider News