Summer 2009

Atlantic Marine will adopt a Provider Paid Health Reimbursement Arrangement benefit

Effective July 1, 2009, Atlantic Marine will add a Provider Paid Health Reimbursement Arrangement (PPHRA) benefit to their employees’ coverage. A PPHRA reimburses the provider, as opposed to a Health Reimbursement Account (HRA) that reimburses the member. Both types of HRAs are funded by the employer for employees and are a benefit offered in conjunction with a high-deductible health plan to pay eligible health care expenses covered under the medical plan. Blue Cross and Blue Shield of Alabama (BCBSAL) will manage the PPHRA benefits for this group, rather than members each managing their own HRA.

The following is a summary of the benefits BCBSAL’s PPHRA offer physicians and other providers:

• Both PPHRA funds and payments from the medical plan will be included in your remittance advice as medical plan payments.

• Since reimbursement is based on your contractual allowances, you do not have to collect any money up front from the member. This eliminates any need for you to  refund to the member any difference between what you collected and the actual payment.

• Once a member's PPHRA funds are exhausted, you may collect the remaining copays, deductible and coinsurance amounts.

The member identification (ID) cards will include a PPHRA logo in the lower right-hand corner to indicate coverage.

In addition to the ID card, members received a flyer from BCBSAL explaining this benefit. They were instructed to bring the flyer to the provider’s office after the benefit becomes active.

When you submit an eligibility and benefits request through the Availity^®1 Health Information Network, you will be able to view the PPHRA account balance on the response transaction. If you have questions regarding the member’s benefits call BlueCard Eligibility at (800) 676-BLUE (2583).

Remember to file these claims directly to Blue Cross and Blue Shield of Florida and contact the Provider Contact Center at (800) 727-2227 for claim inquiries.