Partners and CeltiCare reach agreement for Comm Care Bridge members
This article is from an e-mail an excerpt of which was forwarded to the department in October.
Partners has reached an agreement in principle with CeltiCare on the terms of our participation in the provider network for Comm Care Bridge members. As you recall, these individuals are legal immigrants who were formerly on Commonwealth Care and have been automatically enrolled into the CeltiCare Comm Care Bridge plan. This agreement will be retroactive to October 1 st, which is the date that these individuals were enrolled in the Boston area.
Which Partners sites are in the network?
- MGH, the MGH health centers, and the MGPO
- BWH, the BWH health centers, and the BWPO
- NSMC, the NSMC health centers, and the North Shore Physicians Group
- Martha’s Vineyard and Nantucket Cottage Hospitals and their employed physicians
Which Partners sites are NOT in the network?
- NWH
- McLean
- Partners skilled nursing facilities (this is because SNF benefits are not covered benefits for Bridge members)
- Partners Home Care (this is because home care benefits are available through Care Centric, a carve out)
Which Partners sites are not technically in the network, but may be included in certain circumstances?
- Faulkner Hospital will not be listed as a participating provider. However, if Bridge patients end up at Faulkner as a result of our normal business operations with BWH, we will be reimbursed for care provided at Faulkner.
- Partners rehab facilities will not be listed as "preferred providers." However, if there is no availability for a Bridge patient in a preferred facility, then Partners Continuing Care facilities may be used for rehab.
What does this agreement mean for operations?
- Transitional authorizations are no longer needed for Bridge patients who are scheduled to get care at Partners sites. Providers will now need to follow the plan requirements for participating providers, outlined in the provider manual at this link: http://www.celticarehealthplan.com/wp-content/uploads/2009/10/CommCare-Bridge-Provider-Manual-hs101609.pdf. See the website www.celticarehealthplan.com for more information.
- Staff may inform Bridge patients that they may continue their care at Partners sites.
Is this arrangement only for CeltiCare's Bridge plan, or is it also for their Commonwealth Care members?
- This arrangement is only for the CeltiCare Bridge plan.
- Just a reminder: The CeltiCare Comm Care Bridge plan is different from the CeltiCare Commonwealth Care plan. CeltiCare has operated a Commonwealth Care plan since July 2009. Membership in this plan is small; there are only 486 members statewide, although certain members (plan type 2a members between 100% and 150% FPL) who fail to pay premiums may be autoassigned to the CeltiCare Commonwealth Care plan if it is the lowest cost plan in the area.
- MGH and BWH are in the CeltiCare Commonwealth Care network for quaternary services only, such as transplants.
- CeltiCare Commonwealth Care patients should not be coming to Partners sites for primary care or routine specialty care.
How can providers tell the difference between CeltiCare Comm Care Bridge members and CeltiCare Commonwealth Care members?
- Members’ cards clearly differentiate between the 2 plans.
- Providers need to look closely at eligibility messages. It may take several clicks, but the word “Bridge” will display if it’s a Bridge member.
- Both MGH and BWH have a plan code specifically for Bridge members.
Note: As of 10/23/09, Partners' agreement with CeltiCare for the Comm Care Bridge population has been finalized and is retroactive to October 1st.
-From: “IMPORTANT UPDATE: Partners and CeltiCare reach agreement for Comm Care Bridge members”, e-mail from Kim Simonian, MPH, Associate Director, Patient Access, Community Benefit Programs, Partners HealthCare, October 19, 2009, and “ UPDATE: SIGNED AGREEMENT WITH CELTICARE” e-mail from Kim Simonian, October 23, 2009.
10/09