CONTRACT SUMMARY (Chicago PHOs)

*Risk Managed by APP indicates when claims are paid by Advocate Physician Partners and when referrals are submitted through ERMA

PLAN NAME/PRODUCT NAME/PLAN TYPE Risk Contract
Managed by
APP*
KEY OPERATIONAL ITEMS
Advocate Meridian Health Plan of Illinois

  • Medicaid HMO
  • Referrals and Claims managed/paid by Meridian
Aetna

  • Aetna HMO/POS/EPO/PPO
  • Aetna Open Choice PPO
  • Aetna Choice POS
  • Aetna Choice POS II
  • Aetna HMO
  • Aetna QPOS
  • Aetna Select
  • Open Access Aetna Select
  • Aetna Open Access HMO
  • Aetna Elect Choice HMO (includes Aetna Health Funds)
    Aetna Open Access Elect Choice (includes Aetna Health
    Funds)
  • Aetna Health Network Only
  • Aetna Health Network Option
  • Aetna Open Choice PPO – State of Illinois-SOI
  • Aetna HMO (Formerly Coventry HMO) – SOI
  • Aetna Choice POS II (Formerly Coventry OAP)-SOI
  • Managed Choice POS
  • Managed Choice Open Access PPO
  • National Advantage Program (NAP) PPO
  • Signature Authority (ASA or SRC) PPO
  • Aetna Whole Health
  • Referrals and Claims managed/paid by Aetna
  • Aetna Whole Healthwill no longer be
    offering the Individual Market Place Product
    as of 1/1/2017. Aetna Whole Health products
    will continue to be offered to Employers
    Groups (Self and Fully Insured) until
    12/31/2018.
  • State of Illinois = SOI
Blue Cross Medicare Advantage PPO

  • Choice Plus PPO
  • Choice Premier PPO
  • Claims are paid by BCBS Illinois
Blue Cross Community MMAI HMO (Medicare-Medicaid)
  • Claims are paid by BCBS Illinois
Cigna

  • Cigna HMO / Network
  • Cigna PPO
  • Cigna Choice Fund PPO/EPO
  • Open Access Plus/Choice Fund OA Plus POS
  • Cigna C5 PPO
  • Referrals and Claims managed/paid by Cigna
  • Advocate Physician Partners does not participate in the Cigna Local Plus Network or Cigna Connect
First Health EPO & PPO
Cofinity PPO
  • Claims are paid by Coventry Health Plans
Coventry HMO & PPO
HealthLink / Unicare PPO
HFN

  • HFN Total Care PPO
  • HFN PPO & EPO
  • HFN Platinum EPO
HST Care Connect
Humana

  • Humana Select HMO
  • Humana Platinum HMO
  • Humana Advocate Centered HMO Plan
  • Claims and Referrals are paid/managed by APP
  • Must use ACL Labs for services
Humana

  • Humana PPO
  • Humana Preferred PPO POS-Open Access
  • Humana Advocate Centered EPO Plan
  • Humana Choice POS
  • Humana ChoiceCare/National PPO
  • Humana National EPO/HMO/POS-Open Access
  • Humana Premier HMO
  • Humana Illinois CCN HMO
  • Humana Medicare Advantage Plans
    • Humana Gold Plus – HMO
    • HumanaChoice – PPO
    • Humana Gold Choice – Private Fee-for-service (PFFS)
  • Claims are paid by Humana
  • Humana ICCN HMO is Advocate Only Network
  • Humana Medicare Advantage plans are not an Advocate only network
PHCS & MultiPlan Inc. PPO

  • Private Healthcare Systems (PHCS) PPO
  • PHCS Savility PPO
  • MultiPlan Inc. PPO
SEIU – Local 4 HMO & PPO
Union Medical (Local 1546) HMO
  • Union Medical Referrals are managed by the Union Medical Primary Care Clinic
  • All APP Specialists can receive referrals from Union Medical Primary Care Clinic
United Healthcare

  • United Healthcare/Choice Plus/Select Plus POS
  • United Healthcare Choice Select HMO
  • United Healthcare Core PPO
  • United Healthcare Options PPO
  • United Healthcare Navigate HMO & POS
  • United Healthcare HDHP Definity Basics PPO
  • United Healthcare Medicare Advantage Medicare Solutions PPO/Group Retirees
  • United Healthcare Charter HMO
  • United Healthcare NexusACO R and NexusACO OA
  • Railroad Employees National Health & Welfare Plan

In-Network for United Healthcare Affiliate:

  • Harken Health ChoicePlus
  • Claims are paid by United Healthcare
  • United Healthcare Charter HMO is Advocate only network
  • Railroad Employees Plan is a UHC Choice Plus Product Network/Claims are paid by United Healthcare
United Healthcare

  • AARP Medicare Complete HMO
  • AARP Medicare Complete ACCESS HMO
  • AARP Medicare Complete Plan 1 HMO
  • AARP Medicare Complete Plan 2 HMO
X
  • Claims and referrals are paid/managed by APP
  • Must use ACL Labs for services
  • EXCEPTION: If ID card does not include the Advocate Health logo then claims are billed to UHC address on the ID card