Provider Office Guide - Blue KC

1 blue cross and blue Shield of Kansas City is an independent licensee of the blue cross and blue Shield Association. Provider Office Guide A Reference Manual for blue KC Practitioners Away From Home Care blue KC Provider Office Guide Effective: December 2017 Page | 1 Provider Hotline: 816-395-3929 Provider Office Guide The blue KC Provider Office Guide has been developed to provide you and your staff with basic, important information about blue cross and blue Shield of Kansas City ( blue KC). The Office Guide is intended to assist you in understanding the key policies and procedures applicable to your practice.

2 The Provider Office Guide consists of several stand-alone modules of related information. Away From Home Care (AFHC) blue KC Basics blue KC Networks Descriptions BlueCard Claims, Billing and Remittance Contact | Resource Directory Federal Employee Program (FEP) Health Services Medicare for Other blue Plans New Directions Behavioral Health(NDBH) Provider Credentialing andContracting Specialty ServicesThe Provider Office Guide modules are updated as needed and can be found at on the Resources page. blue KC also communicates changes and updates periodically through our eNewsletter, BlueSpeak, or by mailing information.

3 If you are not able to access the internet, contact your Provider Relations Representative to request a printed or electronic copy be sent to you. Note: In accordance with Article Compliance with Policies and Procedures of the Physician Network Agreement/Physician Participation Agreement including any incorporated Amendments you agree to comply with all rules, regulations, procedures and administrative policies and programs outlined in the Provider Office Guide . blue KC Provider Office Guide Away From Home Care Module Away From Home Care blue KC Provider Office Guide Effective: December 2017 Page | 2 Provider Hotline: 816-395-3929 Table of Contents Provider Office 1 What is AFHC?

4 3 Guest Membership .. 3 Coverage and Benefits .. 3 Provider Information .. 4 Away From Home Care blue KC Provider Office Guide Effective: December 2017 Page | 3 Provider Hotline: 816-395-3929 What is AFHC?Away From Home Care (AFHC) is an out-of-area program sponsored by the blue cross and blue Shield Association (BCBSA) that is available to select HMO members. AFHC enables members to receive Guest Membership coverage and benefits from other participating Blues Plan HMOs, while temporarily residing outside of the home Plan HMO service area.

5 The member must contact his or her home Plan to confirm the out of area location participates in the AFHC program. Members must complete a guest application with their home Plan to be considered for a Guest membership. Coordination of the AFHC guest enrollment, PCP assignment and Blues Plan billing is tracked by AFHC coordinators. Blues Plan AFHC coordinators from each Blues Plan work together throughout the duration of a guest enrollment period to ensure all aspects of the program run smoothly. Guest Membership This service provides courtesy enrollment in a Blues Plan HMO outside the member s home Plan service area.

6 Members have access to a comprehensive range of benefits, including routine and preventive services. HMO members may obtain a Guest Membership if they plan to stay in the other Blues Plan HMO location for 90 or more consecutive days. Guest Membership types include: Families Apart Available to spouses and dependents living away from the member s home Plan HMO service area and residing in another Blues Plan service area. Long-term traveler Available to members with dual residence or long-term work assignments. Membership is limited to six months.

7 Students Available to dependents who enroll in an out-of-area school. Coverage and Benefits Guest members enjoy the full range of benefits/services offered by another Blues Plan HMO. Covered benefits include in and outpatient services and other medical care, including routine and preventive care. When blue KC functions as a host Blues Plan for a guest, members access blue -Care. There is a high and low benefit option available to members. The main Away From Home Care blue KC Provider Office Guide Effective: December 2017 Page | 4 Provider Hotline: 816-395-3929 difference between these options is member copayment amounts.

8 Copayment information is on the member identification (ID) card. Guest members must select a PCP, but are free to self-refer within the blue -Care specialist physician network. Provider Information blue KC will advise you of any AFHC/Guest members assigned to you. Claims should be filed to blue KC and payment is directed to the physician. If you have questions about a patient s eligibility as a Guest member, call ourAway From Home Care number (see Contact | Resource Directory). The PCP s name and phone number is on the member s ID Card.

9 A special prefix, preceding the policy number, is assigned to blue -Care guest(see sample member ID card below). blue KC Basics blue KC Provider Office Guide Effective: December 2017 Page | 1 Provider Hotline: 816-395-3929 blue KC Provider Office Guide blue KC Basics Module Provider Office Guide The blue KC Provider Office Guide has been developed to provide you and your staff with basic, important information about blue cross and blue Shield of Kansas City ( blue KC). The Office Guide is intended to assist you in understanding the key policies and procedures applicable to your practice.

10 The Provider Office Guide consists of several stand-alone modules of related information. Away From Home Care (AFHC) blue KC Basics blue KC Networks Descriptions BlueCard Claims, Billing and Remittance Contact | Resource Directory Federal Employee Program (FEP) Health Services Medicare for Other blue Plans New Directions Behavioral Health(NDBH) Provider Credentialing andContracting Specialty ServicesThe Provider Office Guide modules are updated as needed and can be found at on the Resources page. blue KC also communicates changes and updates periodically through our eNewsletter, BlueSpeak, or by mailing information.