hometown health october 2, 2013. state health network – shbp blue open access pos 17,674...
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State Health Network – SHBP
Blue Open Access POS17,674 Physicians
182 Hospitals
BlueCard® PPOTraveling benefits outside of
Georgia
• Hometown Health hospitals participate in Blue Open Access POS
• All Blue Open Access POS reimbursement arrangements were negotiated prior to the SHBP award. Rates have not changed.
• All contracts are evergreen.• Today, BCBSGa represents on
average less than 5% of Hometown Health hospitals’ total patient revenue.
Hometown Health in Blue Open Access POS
State Health Network – SHBP.
In Georgia • Blue Open Access POS (reimbursement)• No PCP required• No referrals required• Out-of-network benefits
Outside of Georgia• BlueCard PPO for traveling benefits
SHBP Network Communication Plan
Being in the know.Customized communication introducing SHBP programs and resources
• Bi-monthly Network Bulletins will have a special section dedicated to SHBP news
• eBlasts as needed to deepen provider awareness of SHBP specifics
• Provider pages at bcbsga.com with dedicated SHBP real estate
• Webinars in November for providers to learn even more
• Outreach as needed with providers
• Dedicated provider resources
SHBP Member ID card
Network in GA: this is the reimbursement you can expect
PPO “suitcase” for traveling benefits
SHBP Precertification DetailsAdditional services requiring pre-certification for SHBP members include, but are not limited to:
• Outpatient MH/SA (13 visits and over provided by out of network providers)
• Nutritional / Enteral Therapy• Home Health Care• Home Infusion• Ankle Arthroplasty and Bi-Compartmental
Knee Arthroplasty• Dental Services due to accident
• 1300+ health plans in one place• 20+ Blue Cross and Blue Shield plans, commercial payers and more
• File claims, check eligibility, review clinical history, process payments and more
• Accessible 24/7 from any computer with Internet access• Real-time information exchange means highest accuracy of information
from health plans• Simple to use.
• Consistent look and feel • Expert client service representatives and free training • Use with your existing practice management system
• No-cost and premium solutions fit every practice.
Ease of doing businessavaility.com
Multiple payers. One website. One Login.
Interactive Care Reviewer (ICR) Utilizing cutting edge IBM Watson™ Technology Self - Service Provider Web tool
• Initiates precertification requests online more efficiently and more conveniently
• Allows providers to request outpatient procedures for SHBP members
SHBP Contact InformationDedicated Provider Customer Service:
Phone: 855-641-4862
Claims or correspondence should be mailed to: Blue Cross and Blue Shield of GeorgiaP.O. Box 105370Atlanta, GA 30348-5370
We appreciate your service to our members, your patients..
Hospital Contractor Contact e-mail address
Network Management Consultant Contact e-mail address
Appling Hospital Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Archbold Memorial Hospital
Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Berrien County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Bleckley Memorial Hospital
Joseph Jay (706) 985-2549 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Brooks County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Burke Medical Center Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Charlton Memorial Hospital
Cheryl Holyfield (404) 842-8339 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Chatuge Regional Hospital & Nursing Home
Christy Cunningham (770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]
Chestatee Regional Hospital
Christy Cunningham (770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]
Clearview Regional Medical Center
Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Clinch Memorial Hospital
Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Crisp Regional Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Doctor's Hospital of Tattnall
Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Dodge County Hospital Joseph Jay (706) 985-2549 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Hometown Health Provider Relations
Hospital Contractor Contact e-mail address
Network Management Consultant Contact e-mail address
East Georgia Regional Medical Center
Debra Smalley (404) 848-2303 [email protected] Julie Hullum (706) 228-3912 [email protected]
Effingham Hospital Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Elbert Memorial Hospital
Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Emanuel Medical Center
Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Evans Memorial Hospital
Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Fairview Park Hospital Dave Chastain (404) 842-8043 [email protected] Jane O'Connor (706) 602-3057 [email protected]
Flint River Hospital Daniel Steines (706) 985-2548 [email protected] Laura Mendoza (706) 985-2264 [email protected]
Good Samaritan Christy Cunningham (770) 533-5516 [email protected] Maggie Ward (706) 985-2627 [email protected]
Grady General Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Habersham Medical Cener
Christy Cunningham (770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]
Higgins General Hospital
Cheryl Holyfield (404) 842-8339 [email protected] Jackie Hrydziusko (404) 467-2676 [email protected]
Irwin County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Jeff Davis Hospital Cheryl Holyfield (404) 842-8339 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Jefferson Hospital Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Hometown Health Provider Relations
Hospital Contractor Contact e-mail address
Network Management Consultant Contact e-mail address
Liberty Regional Medical Center
Cheryl Holyfield (404) 842-8339 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Louis Smith Memorial Hospital
Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Lower Oconee Community Hospital
Joseph Jay (706) 985-2549 [email protected] Angie Thompson (706) 985-2515 [email protected]
Medical Center of Peach County
Melanie Williams (404) 848-2157 [email protected]
Angie Thompson (706) 985-2515 [email protected]
Miller County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Mitchell County Hospital Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Monroe County Hospital Melanie Williams (404) 848-2157 [email protected]
Angie Thompson (706) 985-2515 [email protected]
Morgan Memorial Hospital
Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Mountain Lakes Medical Center
Christy Cunningham
(770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]
Murray Medical Center Angie Howard (404) 467-2937 [email protected] Jane O'Connor (706) 602-3057 [email protected]
North Georgia Medical Center
Christy Cunningham
(770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]
Northridge Medical Center
Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Optim Medical Center Jenkins
Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Pioneer - Early Memorial Hospital
Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Hometown Health Provider Relations
Hospital Contractor Contact e-mail address
Network Management Consultant Contact e-mail address
Putnam General Hospital
Melanie Williams (404) 848-2157 [email protected]
Toni Key (229) 432-5346 x20 [email protected]
Screven County Hospital
Nicole Early (404) 842-8350 [email protected] Gregory Chatman (404) 842-8693 [email protected]
Smith Northview Hospital
Debra Gee (706) 985-2037 [email protected] Toni Key (229) 432-5346 x20 [email protected]
Taylor Regional Hospital
Melanie Williams (404) 848-2157 [email protected]
Angie Thompson (706) 985-2515 [email protected]
Ty Cobb Regional Medical
Christy Cunningham (770) 533-5516 [email protected] Maggie Ward (706) 985-2627 [email protected]
Union General Hospital Christy Cunningham (770) 533-5516 [email protected] Renee Mason (770) 533-5524 [email protected]
Upson Regional Medical Center
Daniel Steines (706) 985-2548 [email protected] Laura Mendoza (478) 471-4521 [email protected]
Warm Springs Medical Center
Daniel Steines (706) 985-2548 [email protected] Laura Mendoza (478) 471-4521 [email protected]
Washington County Regional Medical Center
Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Wills Memorial Hospital Debra Smalley (706) 228-3918 [email protected] Julie Hullum (706) 228-3912 [email protected]
Hometown Health Provider Relations