Effective January 1, 2020, many of our group members were enrolled in a new benefit design called Preferred Primary Care (PPC). When these members receive care from a designated PPC provider, their copayment is $5. PPC providers are those who have been identified as top performers in Anthem’s Enhanced Personal Health Care value-based model, and can be identified on our ‘Find a Doctor’ tool on anthem.com. Simply choose the plan information and choose PPC in the “Sort by” box for primary care.

We have become aware that many primary care providers who have not been designated as a PPC provider are collecting the PPC copayment of $5, instead of the correct member copayment as indicated on the member’s ID card. If you are not listed as a PPC on our Find a Doctor tool, you should be collecting the other copayment or cost share indicated on the member’s ID card.

As always, it is important that providers are verifying member eligibility and benefits using the ID number on the member’s ID card. This can be done using Availity.com or by calling Provider Service. 

 



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Important update: New Preferred Primary Care benefit design features $5 copayment for services provided by designated preferred primary care providers