BCBSGA Healthcare Exchange Products

There is ongoing confusion over the physician panels that BCBSGA utilized for their healthcare exchange products.  In an effort to address this confusion, BCBSGA has just published updated directories for the new healthcare products that they will be marketing effective January 1, 2014:


This link includes directories for the “Pathway” and “Pathway X” product lines; “Pathway X” products will be sold on the Healthcare Exchange while “Pathway” products will be sold on the commercial marketplace.

BCBSGA confirmed to the Medical Association of Georgia (MAG) that these provider directories are completely accurate and they have removed all physicians who submitted prior opt out notifications to BCBSGA. Therefore, SHP encourages all our clients to view each directory in the above link to determine if your physicians are listed as participating providers.  If your physicians are listed and you previously submitted an opt-out notification to BCBSGA, please contact BCBSGA immediately to inquire about your continued listing in these directories. We would also greatly appreciate it if you could let us know as well.

In addition, the Medical Association of Georgia (MAG) recently met with BCBSGA to obtain clarification about BCBSGA’s new product lines and BCBSGA confirmed that the rate schedules for the Pathway and Pathway X product lines would match the rates from the Direct Access amendments that were disseminated to providers this past spring. If you are included in the Pathway/Pathway X directories, it is critical to understand your Pathway/Pathway X rates as these product lines are not just limited to the healthcare exchange but will be marketed to commercial beneficiaries as well.

Finally, it is anticipated that BCBSGA will be sending HMO plan rate amendments to providers within the next month.  We are significantly concerned about the combined impact from the introduction of the Exchange plans as well as reimbursement adjustments for your BCBSGA commercial product lines; particularly as the number of BCBSGA commercial beneficiaries will be growing significantly effective January 1, 2014 when the State Health Benefit Plan lives transition into the BCBSGA HMO product lines.