Notice about the PAR Network

Beginning January 1, 2019, reimbursement for the Blue Cross and Blue Shield of Georgia, Inc.  Traditional Health Plan Network, also known as the PAR and/or Indemnity Network (herein referred to as “PAR Network”), will be applied to claims submitted for services rendered to PAR Network members only. This means that the reimbursement associated with your PAR Network contract will no longer apply to members with HMO, POS or PPO coverage. This change is being made to assure that our reimbursement structure is consistent along all product lines.

 

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.