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48 11/2005
Reimbursement
The Hospital Agreements for each network the Hospital belongs to establish a
network to service BCBSGa/BCBSHP members. The Participating Hospital Agreement
(Prudent Buyer Program) covers services rendered to our indemnity members. The
Hospital Agreement for Preferred Provider Organization covers services rendered to
our BlueChoice PPO members including FEP members. BlueChoice HMO and
BlueChoice POS services are covered by the Blue Cross Blue Shield Healthcare Plan of
Georgia, Inc. Hospital Agreement.
In the event that a hospital which is not participating in the HMO/POS network
renders services to an HMO/POS member, the hospital will be reimbursed at their
current Participating Hospital Agreement (Prudent Buyer Program) rates.
Pricing methods include but are not limited to: per diem rates, global case rates, per
visit rates, diagnosis related groupers (DRGs), surgical categories (SCs) and
negotiated fee schedules.