Notice about the PAR Network
Your contracted HMO or POS reimbursement will be applied to claims for members who receive benefits thorough a HMO or POS plan. PPO reimbursement will be applied to claims for members who receive benefits thorough a PPO plan. And now, PAR reimbursement will only be applied to claims for members who receive benefits thorough a PAR or indemnity plan.
If you do not participate in a network you will be considered “out-of-network” for members who access benefits through networks in which you do not participate. In the past, the PAR Network, operated as the default network so that if you treated members who accessed benefits through a network in which you did not participate, the PAR Network would drive reimbursement and cost shares. Beginning January 1, 2019, if you treat a member with benefits through a network in which you do not participate, the following will occur: (a) If the Plan has approved the out-of-network care, you must secure a single case negotiated agreement before treating the member and/or (b) if the member self-refers, a single case negotiated agreement is not required but is suggested to help the member receive the highest level of benefits.
Emergency services (as all other services) will be covered in accordance with the members’ benefit plan and governing state and federal laws.
October 2018 BCBSGa Provider Newsletter