October 2013
Bunch TX HCN Service Area Expansion in to final 23 Counties
Bunch CareSolutions has received approval from the Texas Department of Insurance (TDI) for a service area expansion (SAE) to our Texas Health Care Network (TX HCN) filing. The Bunch TX HCN-FH is now certified state wide offering HCN coverage in all 254 Texas counties. This SAE was filed to level set the Bunch TX HCN with our network partner, First Health’s recent HCN expansion. Employees previously excluded from the HCN program will be subject to treating within the expanded HCN coverage after receiving the updated HCN notification, and if living in one of the newly certified counties, allowing employers to capture additional bill volume within the Bunch HCN program.
Employee Notification upon a SAE expansion: HCN regulations require that all affected employees must be notified of the Service Area expansion.
Bunch CareSolutions TX HCN Employee materials have been updated as a result of the SAE. The updated HCN Employee Notification Package includes: Employee Notification Letter, Certified County Map, and Acknowledgement form.
TDI notification recommendation:
· An updated notice of network requirements and employee information and acknowledgment form must be provided to affected employees - 28 TAC §10.26 (f). TDI interprets this to mean “ALL” employees.
· The employer shall obtain a signed employee acknowledgment form each employee - TAC §10.60(f). HCN regulations allow obtaining an electronic acknowledgement.
Bunch CareSolutions & First Health’s notification recommendations:
· Employees living in the 23 counties included in the service area expansion must receive the updated HCN EE Notification Package including Acknowledgement Form.
· Current injured workers should receive the updated HCN EE Notification Package and Acknowledgement
· Any employee that moves from an existing certified county to one of the newly certified 23 counties should receive an updated HCN EE Notification Package and Acknowledgement Form.
· Signed employee acknowledgements should collected and retained
Each client or employer must evaluate their employee population to determine the most appropriate scope and method of document delivery to your employees and current injured workers to maintain compliance. HCN notifications may be distributed by a variety of methods: staff meeting handouts, mail, email, employee payroll stuffer, company intranet access. Employee acknowledgements may be electronic or hard copy.
Replacement updates for work sites, new hires, new injuries:
Bunch CareSolutions TX HCN Employer materials have been updated as a result of the SAE. Employer materials include the HCN Employer Guide and an attached copy of the HCN Employee Notification Package containing the Employee Notification Letter, Certified County Map, and Acknowledgement form.
Employers MUST REPLACE all prior versions of notification materials
a) NEW HIRE packets go forward basis within 3 days of employment date newly hired employees
b) Time of Injury packets go forward basis to all newly injured workers
c) POSTED at each work site location – Bunch will coordinate the updated materials to work sites
Online HCN directories via ProviderNet have been updated to include providers in all certified counties. Current injured workers who access a provider in the newly certified counties will have their provider bills processed as participating HCN providers. Employees that were previously notified will be able to access the newly available providers participating in the newly approved service area via ProviderNet. This will ensure that those employees/injured workers are not affected by the SAE.
Please contact your Bunch CareSolutions account manager with any questions and concerns.