Continued Info on Payor Changes of 2025: Key Insurance Changes
Payors Covered: BCBS of Montana, Blue Shield CalPERS, BCBS of Oklahoma, GEHA
Continued Info on Payor Changes of 2025: Key Insurance Changes
As we move into 2025, several significant changes are coming to key insurance payors that will impact coverage and provider operations. In case you missed previous updates, please reference this page.
This summary outlines the upcoming modifications for BCBS of Montana, Blue Shield CalPERS, BCBS of Oklahoma, and GEHA to help healthcare providers stay informed and prepared.
Blue Cross Blue Shield (BCBS) of Montana 2025 Changes
Starting in 2025, BCBS of Montana's fully funded exchange plans with the prefix YDG will no longer offer out-of-state coverage. Representatives have indicated that facilities can apply for a waiver, but the waiver will be denied if adequate care is available within the state or in contiguous counties.
Blue Shield CalPERS
Effective January 1, 2025, employer-based Blue Shield plans under the group number W0051411 will be handled directly by Blue Shield instead of MHSA.
For more details, refer to the CalPERS official page: CalPERS PERS Gold & Platinum Behavioral Health Programs.
Blue Cross Blue Shield (BCBS) of Oklahoma 2025 Changes
As of 2025, BCBS of Oklahoma's fully funded exchange plans with the prefix YUQ will no longer provide out-of-state coverage. A waiver is available for facilities but will be denied if sufficient care can be accessed within the state or in contiguous counties.
GEHA will transition to UMR
On January 1, 2025, the Government Employees Health Association (GEHA) transitioned from UnitedHealthcare Shared Services to full-service UMR operations.
For updated claim address details and further resources, visit: GEHA Transition Information