Medicare Flashes

Astria Sunnyside Community Hospital Leaving Health Alliance Northwest Network

April 16, 2019

As of April 20, 2019, Astria Sunnyside Community Hospital will not be in-network for SignalAdvantage members except for emergency care or if they receive preauthorization for non-emergency services. Our POS members will still be able to use the hospital and its providers at their out-of-network benefit level.

As stated in a previous flash, although all Astria Sunnyside providers and clinics are ending their contracts with Health Alliance Northwest on April 20 as well, it should have a low member impact. We are also working with other providers in the service area for contracting.

  • Agreements are in place with Prosser Memorial Hospital and its providers, but they’re still in the credentialing process. Prosser has a clinic in Grandview that will offer PCPs and some limited specialties. The hospital and the rest of the providers are in Prosser and Benton City.
  • Agreements are in place with Kadlec and its providers in Richland, but they’re also still in the credentialing process.

As soon as these providers are part of the network, they will appear in the online provider directory search.

If you have questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.

Annual Health Plan Survey Underway

April 2, 2019

The Consumer Assessment of Healthcare Providers & Systems (CAHPS) is currently conducting the telephone phase of the annual Health Plan Survey for commercial, Medicare Advantage and Marketplace members. These calls are coming from the phone number 817-665-8325.

The CAHPS Health Plan Survey is a tool for collecting standardized information on members’ experiences with health plans and their services.

We participate in the CAHPS survey voluntarily as part of our accreditation by the National Committee for Quality Assurance. We use the data collected to improve members’ experiences with providers and the health plan.

We administer the survey with the assistance of a vendor, DSS Research, which has been approved by the Department of Health & Human Services.

If any of your clients contact you about this, please encourage them to participate in the survey so that we can help improve the experience for all of our members.

If you have questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.

New Preferred Cost-Sharing Pharmacy Added in Washington

March 19, 2019

Ulrich’s Valley Pharmacy in Twisp, WA is now a preferred cost-sharing pharmacy for Health Alliance Northwest members, bringing more savings to community residents.

A preferred cost-sharing pharmacy is an in-network pharmacy that has signed a contract with us to offer certain prescription drugs at a lower cost. At these pharmacies, members pay nothing ($0 copay) for Tier 1 generics and only 2 copays for a 90-day supply of their medication.

Ulrich’s Valley Pharmacy, located at 423 Methow Valley Highway in Twisp, will soon appear in our pharmacy search as a preferred cost-sharing pharmacy. Please let your clients in the area know of this new option.

Astria Sunnyside Providers Leaving Health Alliance Northwest Network

March 15, 2019

On April 20, 2019, all active providers under Sunnyside Community Hospital & Clinics (Astria Sunnyside), including Sunnyside Home Health, will no longer be contracted with Health Alliance Northwest.

Letters are going to fewer than 100 members who have an Astria Sunnyside primary care provider (PCP) or who have seen one of these providers in the last 120 days to tell them the provider will no longer be in our network.

The letters don’t include the contract termination date, so members may call you wanting to know when and what to do.

Members must choose another PCP and can do so by calling Health Alliance Northwest Member Services. Fortunately, we still have a robust network of high-quality providers to choose from, and we continue to add providers.  

There is a termination date on the Astria Sunnyside providers in the provider directory (listed as April 19), so members or prospective members who look in the provider directory will see these providers are leaving the network.

Virginia Mason Memorial has the specialty clinic in Sunnyside, and most specialties are available at that clinic.  

We continue to work with other providers in the service area for contracting.

  • Agreements are in place with Prosser Memorial Hospital and its providers, but they’re still in the credentialing process. Prosser has a clinic in Grandview that will offer PCPs and some limited specialties. The hospital and the rest of the providers are in Prosser and Benton City.
  • Agreements are in place with Kadlec and its providers in Richland, but they’re also still in the credentialing process.

As soon as these providers are part of the network, they will appear in the online provider directory search.

If you have questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.

Skilled Nursing Facilities Added to Simplete Tier 1 Coverage in Illinois

March 12, 2019

We are excited to announce that skilled nursing facilities (SNFs) are now included as Tier 1 providers for Simplete Medicare Advantage and Simplete Riverside Medicare Advantage plans.

Please let your clients on Simplete plans know of the following SNF additions to their Tier 1 coverage. 

Simplete Medicare Advantage

  • Country Health Inc. in Gifford, IL (000859)
  • Champaign Living Center in Champaign, IL (377118)
  • Heritage Manor, Danville LLC in Danville, IL (029483)

Simplete Riverside Medicare Advantage

  • Miller Health Care Center in Kankakee, IL (031735)

You can find these and all other in-network providers in our provider search.

If you have questions, call Broker Support at 1-877-917-8489 or email BrokerServices@​healthalliance.​org.​