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State Health Plan Offers New PPO Products to Employees

The State Health Plan is now offering their employees a choice of three Blue OptionsSM PPO products to be effective October 1, 2006. Under the banner of NC SmartChoice, the three plans are NC SmartChoice Basic, NC SmartChoice, and NC SmartChoice Plus, and vary relative to the members' out-of-pocket costs under each plan.

The State PPO product will follow all of the requirements of a BCBSNC PPO plan. We encourage you to learn about the specifications of the new State PPO health plan and how this affects your operations. Remember to check the State Health Plan member’s ID card to verify what plan the member is enrolled in.

BCBSNC will begin accepting precertification requests August 1, 2006, for services to be performed on or after October 1, 2006. Precertification is required for all procedures and services on the Blue Options Prior Plan Approval (PPA) list. If you do not obtain precertification for these services, the claim will be denied, as it would for other BCBSNC Blue Options plans. You will need to supply clinical information along with the request for precertification of PPA procedures.

Mental Health/Substance Abuse services will be administered through Value Options, not Magellan Behavioral Health. Status One will administer the case management services. State PPO members will not be eligible for Member Health PartnershipsSM1 programs through BCBSNC. The State Health Plan has contracted directly with Health Dialog to provide disease management programs.

Watch for more detailed information about the new State PPO plans coming to our Web site and in the fall issue of the BCBSNC provider newsletter Blue Link. Providers can also learn more about the State Health Plan by visiting their Web site at http://statehealthplan.state.nc.us/.