November 15, 2018
Premera acquired Catholic Health Initiative’s Soundpath Health’s Medicare Advantage contract effective January 1, 2019. During open enrollment, these members can decide to stay on their current Soundpath plan and automatically transition to Premera Blue Cross. They don’t need to go through open enrollment.
Here are a few important things to know if your current Soundpath patients decide to stay with a Premera Blue Cross Medicare Advantage plan.
Outpatient Care:
- 2018 patient care: Soundpath Health will continue to manage care for their members through the end of the year. All prior authorization requests and claim payments for 2018 will go through Soundpath.
- 2019 patient care: Soundpath patients who transition to Premera will receive a Premera branded ID card. Manage these patients as you would any member who changes their plan. Ask for their ID card and update their information in your system. You’ll manage their care the same way you would manage any Premera Medicare Advantage patient.
- Referrals: This is a key difference between Premera and Soundpath. Premera requires the primary care provider to manage referrals for their patients and referrals are required for most services even if the provider is in the Premera Medicare Advantage network. This applies to all Premera Medicare Advantage plans and includes requests for most services performed by a specialist. Referrals for members new to Premera’s MA plan in 2019 (including former Soundpath members) can be submitted as early as mid-December by following our normal process and submitting them online or faxing a referral form.
- Prior authorizations: Prior authorizations approved by Soundpath in 2018 that span into 2019 for Soundpath members who stay on a Premera plan will remain in place. We’ll transfer these prior authorizations into our system. You won’t need to submit a new request. For 2019 new or expired authorizations you’ll need to follow the normal process by submitting your request online or faxing a completed prior authorization request form.
Inpatient Care:
- Skilled nursing facilities: On January 1, 2019, Premera will begin managing all skilled nursing facility admissions. This includes members who entered a skilled nursing facility in 2018 and have a continued stay into 2019. For ongoing authorization requests, fill out a Premera Medicare Advantage rehabilitation form request. Submit claims for these admissions to Premera.
- Acute care facilities: Members who are in an acute care facility in 2018 and have a continued stay into 2019 will be managed by Soundpath until the member discharges. Submit your continuing authorization request to Soundpath. Submit claims for these admissions to Soundpath.