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KMAP BULLETIN: Healthy Blue Transitions of Care and Authorizations

Date: 04/01/25

KMAP GENERAL BULLETIN 25071 (PDF)

The purpose of this bulletin is to inform providers of the extension for the Transition of Care period for Healthy Blue through May 31, 2025. Additional time is necessary for Healthy Blue to develop and strengthen relationships with providers and to become acquainted with members, complete assessments and develop responsive and comprehensive care plans.

Healthy Blue will continue to ensure Transition of Care for members who have transitioned from another Managed Care Organization (MCO) by honoring existing service authorizations granted by the previous MCO and compensating authorized providers at no less than 100% of the Medicaid fee schedule.

Healthy Blue will continue the authorizations and service plans from the previous MCO through May 31, 2025.  Providers will receive payments at 100% of the Medicaid fee schedule unless a different arrangement is agreed upon.

Single Case Agreements (SCAs) do not preserve contract rates from the previous MCO and will default to the Medicaid Fee Schedule rate unless otherwise specified and agreed with Healthy Blue.  SCAs honored during transition from the previous MCO will be extended through May 31, 2025, and continuation beyond the Transition of Care period extension is subject to renegotiation.

Extending the Transition of Care period will also offer providers additional time to obtain contracts and complete credentialing by May 31, 2025.

If providers have questions, they may reach out to Healthy Blue using the following contact information:

Healthy Blue