Navigating Recent Payor Changes: BCBS Policies and TRICARE Management Updates
Changes to come in 2025
Navigating Recent Payor Changes: BCBS Policies and TRICARE Management Updates
As 2024 comes to close, significant updates impacting substance use treatment and healthcare access are unfolding. Below, we outline vital changes involving Blue Cross Blue Shield (BCBS) policies and TRICARE management that may affect treatment providers and beneficiaries in various regions.
On Tuesday, December 10th, at our Masterminds Discussion, we will discuss these payor changes and more. See you then!
BCBS Out-of-State Coverage Limitations for 2025: IL, NC, and OK
Beginning January 1, 2025, BCBS plans in certain states will implement new out-of-state (OOS) coverage limitations. These policies may hinder access to care for members traveling or residing near state borders.
BCBS Illinois
Members enrolled in Blue Choice Preferred PPOSM and MyBlue Plus POSSM plans, whether purchased on or off the marketplace exchange, will face restricted OOS coverage beyond the border counties of Wisconsin, Iowa, Missouri, Kentucky, and Indiana.
More information: BCBSIL OOS Coverage Update
BCBS North Carolina
Blue Cross NC’s new HMO plan, Blue Care®, launching in 2025, will provide statewide coverage but limit OOS benefits to urgent and emergency services at the in-network level.
More information: BCBSNC Provider News
BCBS Oklahoma
Members enrolled in Blue Advantage PPOSM and Blue Preferred PPOSM plans, whether purchased on or off the marketplace exchange, will only have OOS coverage within border counties of Kansas, Colorado, New Mexico, Texas, Arkansas, and Missouri.
More information: BCBSOK OOS Benefits Update
TriWest to Manage TRICARE West Effective January 1, 2025
Starting January 1, 2025, TriWest Healthcare Alliance will oversee the TRICARE West Region, impacting healthcare management across 26 states. This shift is crucial for providers and beneficiaries navigating TRICARE’s operational landscape.
Key Details:
Region Coverage: The TRICARE West Region includes states such as Alaska, Arizona, California, Colorado, Texas, and Washington, among others.
Out-of-Network Providers: Specific guidance for OON providers will be available as the transition progresses.
Resources for Providers:
Learn More About TRICARE: TriWest TRICARE Overview
Frequently Asked Questions: Transition FAQs
Provider Lookup Tool: Find Network Providers
Contract Request: Join Our Network
We will continue to share updates as more information becomes available. Providers are encouraged to stay informed and evaluate how these changes may affect their services and patient access.