Keystone 65 Focus Rx HMO Medicare Advantage HMO Defined Network Product

Keystone 65 Focus Rx HMO (Keystone 65 Focus) is a new Independence Blue Cross (Independence) Medicare Advantage HMO benefit product available starting January 1, 2016, to eligible members who reside in Philadelphia, Delaware, Montgomery, Bucks, and Chester counties (i.e., the Independence five-county service area). One of the distinguishing characteristics of Keystone 65 Focus is the size and scope of its provider network, which allows Independence to offer a value-based alternative to our other Medicare Advantage HMO benefit product offerings. Members who choose Keystone 65 Focus will enjoy the same benefits as with broader-network Medicare Advantage HMO benefit products, while taking advantage of lower premiums and out-of-pocket costs due to the defined network.

The Keystone 65 Focus network does not include all physicians, ancillary providers, and hospitals that participate in our Medicare Advantage HMO network. Instead, the Keystone 65 Focus network is a subset of this existing network and consists of more than 23,000 participating providers and 30 acute care hospitals primarily located in Philadelphia, Delaware, Montgomery, Bucks, and Chester counties.

Frequently Asked Questions

Which hospitals are participating in the Keystone 65 Focus network?

If I need to refer a Keystone 65 Focus member to another physician, how do I know if he or she is in the Keystone 65 Focus network?

What are the eligibility requirements to participate in the Keystone 65 Focus network?

If I am a professional provider who is currently not in the Keystone 65 Focus network, how can I participate?

How were admitting privileges determined?

Where can I direct my Medicare patients if they want to learn more about Keystone 65 Focus?

 

Which hospitals are participating in the Keystone 65 Focus network?
Thirty acute care hospitals are participating in the Keystone 65 Focus network, as listed at the link below.

Please note that not all hospitals in the Independence network appear on this list. If a hospital does not appear on this list, it means the hospital is not participating in the Keystone 65 Focus network. Members who choose Keystone 65 Focus for their health care coverage should only be referred to the hospitals listed for non-emergency services.

If I need to refer a Keystone 65 Focus member to another physician, how do I know if he or she is in the Keystone 65 Focus network?
Providers who are participating in the Keystone 65 Focus network can be found using the online provider directory. The online provider directory can be accessed using the Find a Doctor tool or on Independence NaviNet® Plan Central by selecting Reference Tools from the Workflows menu, then Provider Directory. Be sure to select Keystone 65 Focus from the Plans drop-down menu when entering your search criteria.

What are the eligibility requirements to participate in the Keystone 65 Focus network?
The following eligibility requirements apply for the Keystone 65 Focus network:

Ancillary Providers

  • An ancillary provider must currently be participating in our Medicare Advantage HMO network.
  • An ancillary provider cannot be employed by or owned by a hospital that is non-participating in the Keystone 65 Focus network.

Professional Providers

  • A professional provider must currently be participating in our Medicare Advantage HMO network.
  • A professional provider must either have (1) admitting privileges at a hospital that is participating in the Keystone 65 Focus network or (2) a coverage agreement with another physician in their same or similar specialty who is participating in the Keystone 65 Focus network and has admitting privileges at a hospital participating in the Keystone 65 Focus network.
  • A professional provider cannot be employed by, or have their practice owned by, a hospital that is non-participating in the Keystone 65 Focus network.
  • A professional provider is employed by, or has their practice owned by, a hospital that is participating in the Keystone 65 Focus network.
  • A professional provider is located within the primary Independence service area of Philadelphia, Delaware, Montgomery, Bucks, and Chester counties.
  • A primary care physician’s (PCP) current capitation site must be participating in the Keystone 65 Focus network.
  • Certain specialties do not require admitting privileges at a Keystone 65 Focus participating hospital; therefore, these specialties are considered participating if they meet the requirements listed above:
    • Allergy & Immunology
    • Anesthesiology
    • Audiology
    • Certified Registered Nurse/Nurse Practitioner
    • Certified Registered Nurse Anesthetist
    • Chiropractic
    • Clinical Genetics
    • Dermatology
    • Emergency Medicine
    • Occupational Therapy
    • Ophthalmology
    • Optometry
    • Pain Management
    • Pathology
    • Physical Therapy
    • Podiatry
    • Preventive Medicine
    • Radiology
    • Registered Dietitian
    • Registered Nurse
    • Rheumatology
    • Speech Therapy

If I am a professional provider who is currently not in the Keystone 65 Focus network, how can I participate?
If you are a professional provider who is eligible to participate in the Keystone 65 Focus network but you do not meet all of the requirements above, you may be able to do one of the following:

  • Obtain admitting privileges at a hospital that is participating in the Keystone 65 Focus network. Once complete, notify your Network Coordinator.
  • Obtain a coverage agreement with another physician in your same or similar specialty who is participating in the Keystone 65 Focus network and has admitting privileges at a hospital that is participating in the Keystone 65 Focus network. Once complete, notify your Network Coordinator.
  • If you are a PCP and one or more of your existing capitation sites are not participating in the Keystone 65 Focus network, you are required to select a secondary in-network capitation site for all members who are enrolled in the new Keystone 65 Focus benefit product. Contact your Network Coordinator to select a secondary in-network capitation site.

How were admitting privileges determined?
Admitting privileges were based on the hospital affiliation information that was provided to Independence as part of the credentialing process. To be eligible for the Keystone 65 Focus network, at least one practitioner within a practice is required to have admitting privileges (if applicable to your specialty) to a participating hospital in the Keystone 65 Focus network. If you feel the information used to determine your eligibility was incorrect, please contact your Network Coordinator.

Where can I direct my Medicare patients if they want to learn more about Keystone 65 Focus?
Please keep in mind that providers must remain neutral when assisting patients with enrollment decisions. Any discussions with patients should be an objective assessment of the patient’s needs and potential options.

If you have Medicare patients who are interested in learning more about Keystone 65 Focus, please have them contact Customer Service toll-free at 1-800-645-3965 (TTY/TDD: 711), 8 a.m. to 8 p.m., seven days a week. However, please be aware that on weekends and holidays from February 15 through September 30 their call may be sent to voicemail.

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