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BHCG Frequently Asked Questions (FAQs)
For Physicians/Providers
- What providers are included in Humana Preferred (BHCG), a high performance network?
- How are providers reviewed for participation in Humana Preferred (BHCG)?
- What if a provider is not included in Humana Preferred (BHCG)?
- How often will Humana make changes to Humana Preferred (BHCG)? When might providers have an opportunity to join?
- How can physicians be considered for Humana Preferred (BHCG)?
What providers are included in Humana Preferred (BHCG), a high performance network?
How are providers reviewed for participation in Humana Preferred (BHCG)?
Physicians identified as efficient in 20 specialties were evaluated by statistical methods, which identified and measured episodes of care costs, including physician, hospital, ancillary, pharmacy, and laboratory costs. There were additional criteria applied to large physician groups.
Not all Humana Preferred (BHCG) physicians were evaluated in the selected specialties or met the evaluation criteria. Some are included because they practice in a physician group practice which as a whole has met the criteria. Other physicians who have not been evaluated or meet the evaluation criteria are included in order to meet geographic access standards or practice in a unique sub-specialty needed in the network.
If a currently contracted Humana provider did not have enough data available to evaluate, the provider was included in the high performance network plan offering; however Humana will continue to track the provider’s data every six months and once a sufficient number of episodes are realized, the provider’s individual performance will be analyzed for continued participation in the high performance network. Physicians who are just starting their participation with Humana (never have been contracted with Humana as a provider) will be included in other Humana networks and products, except for the high performance network for a minimum of one year, allowing time for the provider to gain sufficient practice data to be analyzed based on Humana’s episode of care methodology.What if a provider is not included in Humana Preferred (BHCG)?
Individual physicians who are part of physician groups participating in Humana Preferred (BHCG) are always included if the group is included. Likewise, individual physicians who are with a group that is a nonparticipating group, are not participating if the group is not participating.
How often will Humana make changes to Humana Preferred (BHCG)? When might providers have an opportunity to join?
Humana will make changes on an annual basis if necessary. Provider participation is based on Humana’s selection process.
How can physicians be considered for Humana Preferred (BHCG)?
If a physician is not currently a participating provider with Humana, they can call Humana’s Provider Relations Department (800) 626-2741 for more information. Note: Physicians who are currently Humana contracted physicians not currently included in the Humana Preferred (BHCG) plan offering will be evaluated annually for possible participation..
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