Health Plan Products - How State Exchanges Have Added Confusion

If you thought it was difficult for your practice to field patient questions that start with “Do you accept?” in the past, health exchange plans have just made it more difficult to answer. Each plan participating in a state exchange has identified or created a network to service members and they vary widely. Look at the exchanges as another plan type as you would Medicare Advantage or a Managed Medicaid and improve the patient experience by having information available to answer their questions.

If a carrier with multiple product lines is now part of the state exchange, you will want to know your status and to make sure all office staffHealthcare Exchange have the information they need. Here are some steps you can take so your staff, practitioners and patients can answer the “Do you accept?” questions.

  • Begin by identifying all exchanges available in your area. Sounds simple, but the research can be difficult. Click here for a list of exchange plans by state.
  • Next, contact each plan to determine which network they are using for their exchange plan. This will take time, but only needs to be done once. In some cases, the plan is making their entire network available, in some they have contracted with an existing national or local network to service the exchange membership and in others, a sub-network has been developed.
  • Next, make a list of the plans accepted by your practice, list your status and start contacting those where there is a question. Ask about your reimbursement for treating exchange patients.
  • Finally, identify gaps and share what you have learned. If you have been excluded from an exchange network, speak to your plan representative and ask if you can be added. If not, make sure your office staff is aware that you cannot schedule exchange patients.

Whether you are a solo practice, a large group or a hospital-based practice, MDeverywhere can manage your health plan enrollment needs. Medical practices have long realized that efficient medical credentialing services are key to realizing all available revenue. The ability to bill and collect on every dollar is critical at a time when most practices are under the dual pressures of reduced reimbursement and increased practice expenses. In addition to lost billing, appropriate credentialing can be critical to maintaining and growing your patient population as patients look to use only participating providers to avoid out-of-network fees.

Efficient enrollment in your region’s plans will help you retain your current patients, grow your practice while reducing write-offs and collection headaches. Having our staff manage the enrollment process and your ongoing re-credentialing needs will enable you to re-allocate office personnel to revenue-generating tasks within your practice.


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