Beginning Sept. 1, 2014, the contract for managing the Texas Teacher Retirement System's TRS-ActiveCare program transfers from Blue Cross and Blue Shield of Texas (BCBSTX) to Aetna. The change does not impact TRS retirees.
TMA has compiled the following list of answers to commonly asked questions to help member physicians work through this transition.
Q. I provided services to a TRS-ActiveCare enrollee in August and will file the claim for payment in September. Will I file the claim to Aetna or to BCBSTX?
A. BCBSTX is responsible for paying all TRS-ActiveCare claims for services provided through Aug. 31, 2014. If services you provide run through August into September, you will need to split the claim by date of services and bill each portion to the correct plan.
Q. What Aetna networks does TRS-ActiveCare use for its plans?
A. The TRS-ActiveCare 1-HD and TRS-ActiveCare 2 plans are Aetna Choice POS II plans. TRS-ActiveCare Select uses the Aetna Select (Open Access) network or the Aetna Whole Health network, depending upon the patient's county of residency. If you are unsure whether you are participating in any of these networks, call Aetna to verify your network status. You also can view the current Aetna TRS-ActiveCare participating physicians in DocFind.
Q. Does TRS-ActiveCare have an exclusive laboratory arrangement?
A. Aetna TRS-ActiveCare has an exclusive arrangement with Quest. Depending upon the patient's TRS-ActiveCare plan, laboratory services Quest provides may be covered at 100 percent. Other laboratories may or may not be in the Aetna-TRS ActiveCare network. Check the Aetna TRS-ActiveCare provider directory to determine network status.
Q. Is Aetna also managing the prescription drug benefit for TRS-ActiveCare enrollees?
A. No. Caremark now manages the prescription drug benefit.
Q. I am an obstetrician-gynecologist with a pregnant patient who is enrolled in TRS-ActiveCare. I am not participating in the Aetna TRS-ActiveCare network. How can this patient continue to see me after Sept. 1, 2014?
A. Your patient MUST complete a Transition Coverage Request form and submit it to Aetna TRS-ActiveCare. Aetna will accept the form before the Sept. 1, 2014, transition date. Your patient should have you complete the provider information and diagnostic/treatment information sections of the form.
Q. How are newborns covered by TRS-ActiveCare?
A. TRS-ActiveCare automatically provides coverage for a newborn child of a covered employee for the first 31 days after the date of birth. To add coverage for the newborn, the covered employee must notify his or her benefits administrator within 60 days after the date of birth. The current enrollment guide also states that the covered employee has up to one year after the newborn's date of birth to add the newborn to coverage if the employee had "employee and family" or "employee and children" coverage with TRS-ActiveCare at the time of birth. TMA has asked Aetna to provide more clarification on this allowance because we have concerns about what the effective date of coverage will be for the newborn and how claims will be processed since they could be past the filing deadline. Once we receive guidance from Aetna, we will update this FAQ.
Q. I obtained authorization from BCBSTX TRS-ActiveCare for a procedure but won't perform it before Aug. 31, 2014. Will the authorization transfer to Aetna TRS-ActiveCare?
A. BCBSTX is providing Aetna with data files of all approved authorizations. TMA recommends contacting Aetna TRS-ActiveCare to verify the authorization is on file. We have asked Aetna TRS-ActiveCare how it will handle appeals if it denies a claim for no authorization when the physician obtained one under BCBSTX. Once we receive guidance from Aetna, we will update this FAQ.
Q. How can I identify which TRS-ActiveCare plan my patient selected?
A. See the examples below of TRS-ActiveCare ID cards. All ID cards will have the ActiveCare logo. If the patient is enrolled in TRS-ActiveCare Select and resides in one of the counties using the Aetna Whole Health accountable care organization (ACO) network, the applicable ACO will be identified on the front of the ID card. See the breakdown below of counties and the Aetna Whole Health networks. Be aware: TRS-ActiveCare Select has NO out-of-network benefits. Unless the services were for emergency care, the patient will be responsible for all the charges. TMA recommends practices obtain a copy of their patient's new Aetna TRS-ActiveCare insurance card and verify eligibility with Aetna. Insurance cards are being mailed to patients; however, it's important to note that an enrollee who changed his or her plan selection after Aug. 11, 2014, will receive an updated card in the mail. Verify that your patient is providing you a copy of the correct insurance card for the date of service.
Important Aetna and Caremark TRS ActiveCare Links
Action, Aug, 15, 2014