Does your office accept BCBS exchange patients?

When the new healthcare reform took place so did the increase in more plans and networks that the payers, like BCBS started to offer to the members. Great! More people are covered and providers are able to see more patients.

However, the problem that the providers are running in is the fact that these plans have their own network. One of these networks is Pathway x Enhanced, offered by BCBS to the members that buy the insurance on exchange website.

Why is this a problem for the providers? Simple, Pathway X Enhanced network is exclusive to only certain Paycard%20300%20200providers that were selected for that network by the BCBS its self. But I am INN with my Local BCBS, can I join the Pathway X Enhanced network too? Unfortunately the answer to that question is NO. Why? Simply put there is a certain criteria that provider needs to meet in order to be in the Pathway X Enhanced network. You could also request the very complicated explanation from BCBS but if you have not received it in the early 2014. LOL

To avoid rejected/denied claims: train your front staff to recognize which patients have this particular coverage and double check the benefits for incoming patients BEFORE they come to the office-making sure that the incoming new patients have OON benefits and you are not incurring charges that you will have a hard time collecting.


Front Staff Training!

Believe it or not most common reason why the claims get denied is-lack of trained FRONT STAFF.

Things like NO OON benefits and collecting improper co-pays are the hindering factors that decrease your cash flow and create unnecessary double work.

I offer an extensive training package- reducing medical billing errors and increasing your cash flow for your practice.

Availability: Thursdays: 9-5pm.

*Client provides own his/her own EMR/EHR software: Kareo, Practice Fusion, ECW, Lytec

Fees: $450- Minimum of 4 sessions* *( the number of training sessions depends on the practice needs)

Area of Coverage: Westchester County

The training hours do not need to be scheduled back to back. You can choose the days and hours.


Have any questions or comments please feel free to contact me.
Email* is the fastest way to get in touch with me: or by phone: 914-338-8074