I saw an article in Crain’s that Affinity is transitioning Medicare members to EmblemHealth. What is happening at this time?
Effective January 1, 2019, Affinity Health Plan will transition its Medicare Advantage Plan members to EmblemHealth. After that date, EmblemHealth will administer the Medicare Advantage contract in accordance with regulatory requirements.
What about the letter I received from Humana and Affinity regarding joining Humana’s provider network?
You can still join Humana’s network and if you have already signed a contract with Humana, nothing will change. However, Affinity will not be transferring its Medicare business to Humana on January 1, 2019.
As a provider, how does this affect my participation in the Affinity network?
This transaction affects only Affinity’s Medicare program, including Affinity Medicare Ultimate, Affinity Medicare Solutions, Affinity Medicare Essentials and Affinity Medicare Essentials NYC. Your participation in other Affinity programs – such as Medicaid, Essential Plan, CHP and HARP – remains in place and is not affected in any way by this transaction.
Are there any changes at this time to how I submit claims and / or requests for authorizations and appeals?
No. You should continue to submit claims, as well as requests for authorizations and appeals, in the same way that you currently do. Until the Affinity Medicare members are transitioned to EmblemHealth – which is on January 1, 2019 – Affinity will continue to process claims, authorizations and appeals and perform all other requirements under its Medicare contract. All claims and appeals for dates of service on or before December 31, 2018 will continue to be processed by Affinity. Dates of service on or after January 1, 2019 will be the responsibility of EmblemHealth.
What about transition of care for my Affinity Medicare patients who are in the middle of treatment?
Affinity’s Care Management staff will work with providers and members, as well as with EmblemHealth, to transition any ongoing care needs that may exist at December 31, 2018.
What if I don’t have a network contract with EmblemHealth at this time?
In order to continue to take care of Affinity’s Medicare members and receive in-network reimbursement beginning January 1, 2019, you will need to have a network participation agreement in place with EmblemHealth. If you currently do not have a network participation agreement with EmblemHealth, and you want to join their network, please call EmblemHealth Provider Customer Service at 1-866-447-9717 during the hours of 8:00am-5:00pm Monday- Friday.
Can I still see my Affinity patients if I don’t want to contract with EmblemHealth?
You can continue to see your Affinity patients through December 31, 2018. You’ll need to be contracted and credentialed through EmblemHealth to see your Affinity patients in 2019.
Can Affinity Members keep their current Affinity Plan in 2019?
At the end of September, all Affinity members were notified about changes to their Medicare benefits for 2019. The benefits outlined in that communication are the same benefits that EmblemHealth will administer on January 1, 2019.
Will Affinity members receive new ID cards?
Yes, EmblemHealth will issue new ID cards to all members.