End of Network Health CommCare Contract Reminder
Open enrollment for the state's Commonwealth Care program ended on July 8th and Commonwealth Care members are now locked into their plans for the next year. Partners HealthCare’s contract with Network Health for their Commonwealth Care product has now officially ended (as reported in the May edition of MGH Community News ).
Possible Scenarios and Responses:
- Patient has Network Health Commonwealth Care, and reports he never saw any information about provider network changes, or that he thought he had switched plans during open enrollment. You may direct these cases to a patient financial counselor.
- Patient has NHP Commonwealth Care or CeltiCare Commonwealth Care, having switched from Network Health Commonwealth Care, but doesn't have the correct PCP. It is NOT too late for Commonwealth Care members to switch PCPs. If a patient has the wrong PCP, you should advise him to call his plan and select the correct PCP. You may direct him to a patient financial counselor for further assistance.
- Patient with Network Health Commonwealth Care shows up for an appointment. As of 7/1, we are no longer contracted with Network Health for Commonwealth Care members. We can continue to see patients in “active treatment” or those who did not get the message that we would be out of network for a transitional period (7/1 - 9/30) at a different reimbursement rate. The normal prior authorization rules apply. Beginning 10/1, however, we will need a plan authorization from Network Health to see a Network Health Commonwealth Care member.
- Patient with Network Health Commonwealth Care is referred from Martha's Vineyard or Nantucket. The Island hospitals were not included in our Network Health Commonwealth Care contract termination, so they can still see Network Health Commonwealth Care patients. As part of this agreement, patients who have a PCP on Martha's Vineyard or Nantucket may also continue to be seen anywhere in the Partners system.
- From “ Network Health Commonwealth Care updates and reminders” Kim Simonian, MPH, Associate Director, Patient Access, Partners HealthCare Community Benefit Programs, July 18, 2011.
7/11