Blue Care Network will offer two new plans, effective August 15:
- MSU Graduate Assistant Health Plan -- Covers graduate assistants at Michigan State University
- MSU Student Health Plan -- Covers students at Michigan State who don't have other health coverage
These new products have unique referral requirements for medical services. There is no change for behavioral health providers. This product follows standard Blue Care Network network and authorization rules for behavioral health.
To help manage the referral requirements for medical services, we've created a new provider network -- the MSU Student Health Services Network. You need to know whether you're in this network in order to know how to handle referrals for these members.
The MSU Student Health Services Network is a unique network of Blue Care Network providers primarily in Michigan's mid region within 45 miles of Olin Health Center, a health clinic affiliated with MSU in East Lansing. Participation in the network will be posted on the Blue Cross online provider
directory by Aug. 15.
Adult members are assigned a primary care physician within Olin Health Center. Pediatric primary care physicians are assigned from the MSU Student Health Services Network.
Referral requirements
Referral requirements differ based on network status. The clinical review program requirements continue to apply. They have not changed. Here's what you need to know about referrals:
Providers in the MSU Student Health Services Network:
Adult members and subscribers under the age of 18 need a global referral issued by the PCP submitted through e-referral for care outside Olin Health Center.
Specialists outside of Olin Health Center need a global referral on file with Blue Care Network and must submit a referral to Blue Care Network for services outside their office, for example a colonoscopy at a hospital within this network.
When submitting an e-referral request for a patient with this coverage, providers in MSU Student Health Services Network will show as "Preferred."
Here are the exceptions (where referrals do not need to be submitted to Blue Care Network -- although standard Blue Care Network clinical review requirements continue to apply):
- Services provided by Olin Health Center
- Services provided to dependent children (members other than the subscriber or spouse who are age 17 and under)
- Certain member subgroups identified by Michigan State (such as visiting scholars and the College of Law)
Blue Care Network providers not in the MSU Student Health Services Network:
Care must be coordinated by the member's PCP but a referral does not need to be submitted to Blue Care Network. All Blue Care Network referral and clinical review requirements continue to apply.
Levels of patient cost-sharing
There are three levels of patient cost-sharing:
- Olin Health Center, Lowest cost-sharing
- Blue Care Network network provider,
but not Olin Health Center, Higher cost-sharing
- Provider not contracted with Blue Care Network
and not with Olin Health Center, Highest cost-sharing
Check eligibility and benefits
When you check eligibility for a member with this coverage on web-DENIS, by calling PARS (the Provider Automated Response System), or through an electronic 270/271 transaction, special messaging will alert you to the local network and special referral requirements for this product.