NY – EMPIRE BCBS Offers New Provider Networks in 2014


6/24/2013 – Empire BCBS has announced that Empire and its Affiliates (excluding Amerigroup and Caremore) are developing new individual and small group health benefit plans beginning on January 1, 2014, and will build new limited provider networks to support the new plans. The provider networks that will support individual benefit plans will be called the “Pathway Enhanced” or “Pathway X Enhanced” networks (collectively the “Pathway Enhanced Network”).  Provider networks that will support the group health benefit plans will be called the “Pathway”  and “Pathway X” networks (collectively called the “Pathway Network”).


Based on established criteria, a subset of Empire’s participating physicians and health care practitioners will be selected to participate in the Pathway Networks and those providers will receive a notice and an amendment in early July outlining the terms for reimbursement under these new plans.


Participating physicians and healthcare practitioners that have not been selected to participate in the Pathway Enhanced Network and Pathway Network will receive notification of their exclusion from these networks, but will still remain as participating providers in Empire’s other provider networks, as applicable, under the provider’s agreement with Empire.


With the exception of physicians, health care practitioners, hospitals, and ambulatory surgery centers who will receive amendments under separate cover, all other providers shall have their agreements unilaterally amended (to the extent permissible) by means of this notification and consistent with the notice period in the contract to include the Pathway Enhanced Network and Pathway Network.