Provider Network FAQs
- What is a preferred provider?
- Why would I use a preferred provider?
- What if I don't use a preferred provider?
- How do I find a preferred provider?
- My doctor isn't a preferred provider — now what?
- What is the maximum allowed charge?
What is a preferred provider?
Preferred providers are doctors, hospitals and other health care providers who have agreed to provide medical services at negotiated rates and at designated standards.
Why would I use a preferred provider?
While there is no requirement to use a preferred provider other than the hospitals for active employees and dependents, there are advantages. Preferred providers will file your claims for you and since they may provide services for a discounted rate, using one can lower the cost to you and to the plans.
What if I don't use a preferred provider?
Non-preferred providers may ask you to pay for services up front and file a claim for reimbursement, although many do not have this requirement. Claims from a non-preferred provider are reimbursed based on the maximum allowed charge. If the provider you use charges…
- Less than or the same as the maximum allowed charge: both you and your plan will pay according to the plan co-pay percentages and deductibles using the actual amount charged; or,
- More than the maximum allowed charge: after you and the plan pay according to the plan copay percentages and any deductible using the recognized charge guidelines, you may be asked to pay the amount charged by the provider that exceeded the maximum allowed charge.
How do I find a preferred provider?
The plans include access to preferred providers through the MultiPlan (formerly Beech Street) network and their affiliates. There are several ways to locate a preferred provider:
- Use the provider locator at AlaskaCare Provider Locator . You may search for a provider by name, specialty or location. Instructions for making the best use of the provider locator are available at AlaskaCare Provider Search Instructions
- Call HealthSmart at (877) 517-6370 or MultiPlan at (866) 720-3725 for additional assistance.
My doctor isn’t a preferred provider – now what?
You may encourage your doctor to become a preferred provider. You and/or your provider can simply contact MultiPlan at the number listed above. If your provider does not choose to join the network, you may make a choice whether to continue as a patient or change to a preferred provider.
What is the maximum allowed charge?
Claims payment is limited to the maximum allowed charge for eligible services. If a charge exceeds the maximum allowed charge, the amount above the maximum allowed charge is not covered by the Plan, and is your responsibility to pay.
The maximum allowed charge is the charge contained in an agreement the claims administrator has with the provider either directly or through a third party. If no agreement is in place, the maximum allowed charge is determined in accordance with the provisions of this section 3.2(d).
To determine the maximum allowed charge, the Plan utilizes the benchmark data on healthcare charges compiled by and licensed from FAIR Health, Inc. The benchmarks are based on 12 months of charges and are arranged in percentiles by procedure codes and geozips.
Procedure codes are codes (alpha/numeric) assigned to services and procedures performed for patients by medical and dental practitioners. Each code number is unique and refers to a specific medical service or procedure. For purposes of determining the maximum allowed charge, the procedure codes utilized are the Current Procedural Terminology, or CPT codes owned and licensed from the American Medical Association. For dental procedures, the Code on Dental Procedures and Nomenclature, or (CDT) codes, owned by and licensed from the American Dental Association, are used.
Geozips refer to geographical areas generally organized by the first three digits of the U.S. zip codes. For purposes of determining the maximum allowed charge, the State of Alaska is divided into three geozips:
|Area#1 – Geozip 996||Area#2 – Geozip 995||Area#3 – Geozip 999||Zip Codes that begin with 996 or 998||Zip Codes that begin with 995 or 997||Zip Codes that begin with 999|
Thank you for taking the time to review this important information. We hope it improves your AlaskaCare experience.