The Connection Online SM
August 2011
Regence BlueShield will administer KingCareSM Plan in 2012
Note from the Editor (1/26/12): Updated the second paragraph to reflect that Regence will provide customer service and claims processing, as well as respond to preauthorization requests, appeals, and medical reviews with support from the National Alliance platform in Columbia, South Carolina.
On January 1, 2012, Regence BlueShield will begin administration of KingCare, King County's self-insured health plans.
Regence will provide customer service and claims processing, as well as respond to preauthorization requests, appeals, and medical reviews via the National Alliance platform in Columbia, South Carolina. Member Explanation of Benefits will be sent from the Columbia, South Carolina service center.
Network
KingCare will use the Regence preferred provider organization (PPO) network within the Regence service area. Members traveling or residing outside the Regence service area will have access to the BlueCard® PPO and the BlueCard Worldwide networks.
Benefits and member cards
Services covered by the plans as well as deductible, coinsurance and copayment amounts will not change in 2012. Express Scripts® will continue to administer the pharmacy benefits for both retail and mail order prescriptions.
King County will continue to determine benefits for their employees and retirees. Cards for King County members will include a specific alpha prefix and group number. See the sample card below.
Notes: Regence member cards will only include the subscriber name. The sample card is meant to be a guide and may not match the specific King County card(s).
Customer Service
You can begin contacting the new customer service number at 1 (855) 229-5717 on December 1. Contact Customer Service for benefit and eligibility related questions from 6 a.m. to 6 p.m. Pacific Time.
As a Regence network provider, you will be able to verify eligibility and benefits via My Insurance Manager for Providers. See below for more details about this secure website. You will receive your payment voucher and explanation of claims processing from Regence BlueShield.
Questions related to your Regence provider contract will continue to be directed to your Regence professional relations representative.
My Insurance Manager, BlueCross BlueShield of South Carolina's secure online portal, provides free access to patient information, benefits, pre-authorization requirements and more. Physicians, dentists, other health care and dental professionals and facilities can find real-time information about benefits using My Insurance Manager for Providers.
While using My Insurance Manager, providers can:
- Check member eligibility*
- View the status of members' claims
- Check deductible and out-of-pocket status
- Read member benefits and coverage information
- Check to see if a patient has other health or dental insurance
- Submit an authorization request and verify authorization status for inpatient and outpatient visits**
*Historical eligibility information is not accessible online.
**Authorizations from Aetna that span into 2012 will be transitioned to BlueCross BlueShield of South Carolina to support a smooth transition of care for King County members.