Keystone First. Provider Network Management. 200 Stevens Drive Philadelphia, PA 19113 Fax: 1-215-937-5343. Medical Provider Change Form. page 3 of 3. Title: Provider Manual | May 2023. Primary Care | Specialist | Ancillary | Hospital . KF_232717100-1 Call 1-800-573-4100 from 8:00 a.m. until 6:30 p.m. or fax a member intervention request form (PDF) to 1-800-647-5627. 2. Refer a patient to the complex case management program. Complex case Management is a voluntary program focused on prevention, education, lifestyle choices and adherence to treatment plan and is designed to support …If you need more information or can't find an answer to your question, check your provider manual (PDF). You can also call Keystone First Community HealthChoices Provider Services at 1-800-521-6007. Our user-friendly tools and resources are designed to support you and your staff in giving members excellent and efficient health care. Important contact information. Provider Services. 1-800-521-6007. Prior authorization. 1-800-521-6622. Keystone First maintains and adheres to all applicable state and federal standards and regulations, Department of Human Services (DHS) requirements, and accreditation requirements governing credentialing and recredentialing functions. All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF). If you have questions about this tool or a service or to request a prior authorization, call 1-800-521-6622. Find out if a service needs prior authorization. Type a Current Procedural Terminology (CPT) code in the space below to get ... Note: Use this application if you are joining an existing Keystone First participating group or health care facility and you would like to become a participating provider. Practitioner application checklist. Opens a new window. (PDF) Fax all applicable items on this checklist to 1-877-759-6221. Or, you may scan your signed documents and submit ... Then call Member Services at 1-800-521-6860 to request the change. Nurse Call Line 1-866-431-1514. When you join Keystone First, you choose a Primary Care Practitioner (PCP). Your PCP oversees your health care. He or she is responsible for taking care of your health and, when necessary, arranging care for you from other health care providers. Keystone First is a Medical Assistance (Medicaid) managed care health plan that was founded by the Sisters of Mercy in 1982 to help people get care, stay well, and build healthy communities. Today, we remain committed to that mission. Headquartered in Philadelphia, Keystone First offers all the benefits and services of regular Medical Assistance.March 26, 2024. Electronic Remittance Advice (ERA/835) Access – March 26, 2024 Update (PDF) March 26, 2024. Claims Timely Filing Deadline Extension – March 26, 2024 Update (PDF) March 22, 2024. Nursing Facility Availity Claims Editing Issue - March 22, 2024 Update (PDF) March 19, 2024. Change Healthcare System Interruption - March 19, 2024 ...Members may self-refer for routine family planning services and may go to any physician or clinic, including physicians and clinics not in the Keystone First network. Members that have questions or need help locating a family planning services provider can be referred to Member Services at 1-800-521-6860.If you have any questions or need help finding a provider, call Member Services at 1-800-450-1166 (TTY 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31. We can also mail a hard copy of the provider directory to you. Y0093_001_232792656. …Top 10 Keystone Mercy Health Plan Provider Specialties in New Jersey: · Dermatologist (Skin Specialist) (5 providers) · Anesthesiologist (2 providers) · Pain&n...Providers may contact the Let Us Know program staff when they identify a member who needs behavioral . health assistance or intervention. Call the Rapid Response and Outreach Team from 8 a.m. to 6:30 p.m. at . 1-800-573-4100. www.keystonefirstpa.com3 days ago · Add your insurance to see in-network doctors. See all (1,000+) 188 verified Keystone First Doctors in your area. Learn more about Zocdoc search. Zocdoc Doctors Keystone First. Find Keystone First Doctors & Providers with verified reviews. Make an appointment online instantly with Doctors that accept Keystone First insurance. It's free! Providers can view and download an electronic remittance pdf via the NaviNet provider portal. Providers may also access the (ERA/835) file through ECHO Health. For additional information, please see the recent 835 Access provider notice.The providers are then given a score, on a scale of 1 to 4, based on their ranked performance, with 4 indicating highest overall performance. The Referral Guide identifies program participating providers and includes an indicator for those performing providers with performance above the network average.Coronavirus (COVID-19) Keystone First is committed to offering a dental benefit program that ensures access to high quality oral health care. To realize our commitment to our members, providers and stakeholders, Keystone First is contracting directly with dental providers to foster closer relationships between the health plan, our participating ...P.O. Box 541 Milwaukee, WI 53201. Provider complaints. To make an inquiry or complaint, contact Keystone First’s Provider Services department toll-free at 1-877-408-0878. To fle a written complaint, send complaint to the following address: Keystone First – Complaints P.O. Box 1383 Milwaukee, WI 53201. Provider appeals information.Third Party Liability and Coordination of Benefits Third Party Liability (TPL) is when the financial responsibility for all or part of a Member's health care expenses rests with an individual entity or program (e.g., Medicare, commercial insurance) other than Keystone First. COB (Coordination of Benefits) is a process that establishes the order ...Keystone First Stat Lab List - Providers - Keystone First Author: Keystone First Subject: Keystone First Stat Lab List Keywords: stat lab list, laboratory services, cpt codes, keystone first, keystone first health plan, pa health care, pa medicaid, medicaid managed care Created Date: 5/20/2013 10:01:28 AMKeystone First is a Medical Assistance (Medicaid) managed care health plan that was founded by the Sisters of Mercy in 1982 to help people get care, stay well, and build healthy communities. Today, we remain committed to that mission. Headquartered in Philadelphia, Keystone First offers all the benefits and services of regular Medical Assistance.May 16, 2023 · The updated 2023 Keystone First Provider manual is now available online. May 16, 2023. Keystone First is pleased to announce the availability of the 2023 Provider Manual. Examples of updates and changes include topics such as: Prior Authorization Lookup tool: Added information required to properly assess a Provider’s request for prior ... Someone may be reaching out to you to answer a satisfaction survey about the health services you get from Keystone First CHC. Your answers can help make sure you get the best care and service from us. If you have any questions or want to know more about the survey, please call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976) 24 …Contact information: Philadelphia VFC program. 1-215-685-6728. Providers in all other Pennsylvania counties should contact: PA Department of Health Vaccines For Children program. 1-888-6-IMMUNIZE (1-888-646-6864) EPSDT Department assists the Parents or Guardians of all members younger than twenty-one (21) years of age in receiving EPSDT …Call 1-800-573-4100 from 8:00 a.m. until 6:30 p.m. or fax a member intervention request form (PDF) to 1-800-647-5627. 2. Refer a patient to the complex case management program. Complex case Management is a voluntary program focused on prevention, education, lifestyle choices and adherence to treatment plan and is designed to support …Sep 1, 2566 BE ... Keystone First, a Medicaid assistance provider that serves the Delaware Valley, is doing something to help members of the community that have ... Community Account Executive Director: Kim Beatty, 1-215-863-6614. 1-267-835-6189 (cell) [email protected]. Community physicians. Philadelphia College of Pinnacle Physicians Group, LLC • Oxford Circle Family Medicine. Osteopathic Medicine (PCOM) • Dr. Murray Brand and Associates • Arrow Family Medicine. Network providers must utilize their assigned laboratory when outpatient laboratory studies are required for their Keystone First members. The only exception to this rule is STAT laboratory services. STAT laboratory services are defined as: Laboratory services that require completion and reporting of results within 4 hours of receipt of the ...NUMBER. December 19, 2018. December 19, 2018. 99-18-11. Service Location Enrollment Deadline. BY. Sally A. Kozak, Deputy Secretary Office of Medical Assistance Programs. IMPORTANT REMINDER: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every 5 years. Providers should log into …Keystone First fully supports and encourages all providers to follow the CDC's recommendation of how healthcare providers can prevent the spread of antibiotic resistance by: Only prescribing antibiotic therapy when it is likely to be beneficial to the patient. Using an agent targeting likely pathogens.Ordering and Dispensing Blood Pressure Monitors. As a reminder, Keystone First/Keystone First CHC providers who believe their patients would benefit from an automatic blood pressure monitor (A4670) should give them a prescription that can be taken to any participating network pharmacy or DME supplier. The pharmacy or DME supplier will dispense ...Keystone First, coverage by Vista Health Plan, an independent licensee of the Blue Cross Blue Shield Association. This site contains links to other Internet sites. Keystone First is not responsible for the content of other Internet sites.Patient acknowledgement form for hysterectomy - Providers - Keystone First Author: Keystone First Subject: Patient acknowledgement form for hysterectomy Keywords: Patient acknowledgement form for hysterectomy, hysterectomy, forms, Keystone First, Providers Created Date: 4/19/2006 2:51:38 PMFebruary 15, 2024 (PDF) View our provider webinars, including patient-centered medical home.Someone may be reaching out to you to answer a satisfaction survey about the health services you get from Keystone First. Your answers can help make sure you get the best care and service from us. If you have any …Keystone First encourages all of our participating providers to do their part in striving to meet the needs of our culturally diverse membership. Any practitioner with a question regarding the provision of services to members with Limited English Proficiency may contact our Member Services Department at 1-800-521-6860 .Are you in the market for a new home in Horsham, PA 19044? Look no further than Zillow.com, an online real estate marketplace that can help you find your dream home with ease. Hors...Effective immediately Keystone First and Keystone First CHC will not require an authorization for the Durable Medical Equipment (DME) procedure codes listed on the attachment included with this notice. This authorization policy will be in place while a valid disaster declaration authorized by the Governor for the COVID- 19 virus remains in …Provider Claim Refund Form - Providers - Keystone First Author: Keystone First Subject: Provider Claim Refund Form Keywords: Your satisfaction is important to us. To ensure your refund is handled to the best of our ability, we request that you fully complete the Provider Refund Claim Form. keystone first, provider claim refund form, claim ...All items listed below are required for the Organizational Provider to participate with Keystone First, Keystone First VIP Choice, and/or Keystone First Community HealthChoices. Please use this Application Checklist as a fax cover sheet. Fax all applicable items on the checklist to the Credentialing department at. 1-877-759-6221.Jan 1, 2020 · Language services at the office. Call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976) 24 hours a day, 7 days a week. Provider data in the online directory is updated daily Monday through Friday. As a Keystone First Community HealthChoices Participant, you have a network of committed health care providers ready to take care of you. We ask that any provider who will be closing their office for an extended period of time notify Keystone First and Keystone First CHC Provider Services at 1-800-521-6007, and indicate whether virtual visits, telephonic consultation, and/or secure web-portal consultation will be available for Members/Participants during this period.Community Account Executive Director: Kim Beatty, 1-215-863-6614. 1-267-835-6189 (cell) [email protected]. Community physicians. Philadelphia College of Pinnacle Physicians Group, LLC • Oxford Circle Family Medicine. Osteopathic Medicine (PCOM) • Dr. Murray Brand and Associates • Arrow Family Medicine.Provider Manual and Forms. 2023 Keystone First Provider Manual updates (PDF) Download the 2023 Provider Manual (PDF) ... PA EPSDT periodicity schedule and coding matrix (PDF) ... Keystone First, coverage by Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of ...Sep 1, 2566 BE ... Keystone First, a Medicaid assistance provider that serves the Delaware Valley, is doing something to help members of the community that have ...As you are aware Keystone First and Keystone First Community HealthChoices (CHC) are using the same prior authorization guidelines as required by Pennsylvania Department of Human Services (DHS) for drugs included in the statewide preferred drug list (PDL). This change was implemented on January 1, 2020. WeTo check on the status of your credentialing application, simply call Keystone First's Provider Services at 1-800-521-6007 . Follow the prompts to check on your credentialing application. You can also inquire about the status of your application or submit questions via email to [email protected]. Top of Page.Find a provider . Member portal login . Providers. Provider Homepage Join our network Find a provider ... If you have questions about the member portal or Keystone First, call Member Services at 1-800-521-6860 (TTY 1-800-684-5505). Members. Find a Doctor, Medicine, or Pharmacy; Member portal; View your benefits; Getting care;To begin the contracting process you must complete the contracting application (PDF).Please email it to [email protected] or fax to 215-863-5472.; Keystone First will then email you a contract with instructions for signing and return.Call 1-800-573-4100 from 8:00 a.m. until 6:30 p.m. or fax a member intervention request form (PDF) to 1-800-647-5627. 2. Refer a patient to the complex case management program. Complex case Management is a voluntary program focused on prevention, education, lifestyle choices and adherence to treatment plan and is designed to support …Keystone First has developed a series of tools and programs so providers can identify these patients and work with us to reduce the number of avoidable readmissions. 1. Use admit and discharge reports available through NaviNet. Visit NaviNet daily for customized reports that provide snapshots of patients who have been admitted to, or discharged ...By email. For medical providers: [email protected]. For LTSS providers: [email protected]. By phone. Keystone First …Keystone First 200 Stevens Drive Philadelphia, PA 19113. Driving directions. By telephone. Main telephone number 1-215-937-8000. Member Services 1-800-521-6860 TTY: 1-800-684-5505 Representatives are available 24 hours a day, 7 days a week. Provider Services 1-800-521-6007 Representatives are available 24 hours a day, 7 days a week. By emailIs approval required from my primary care physician? I'm currently a network provider ... KEYSTONE MERCY/ KEYSTONE FIRST) UNITED HEALTHCARE ... PA 19110. info@ ...All items listed below are required for the Organizational Provider to participate with Keystone First, Keystone First VIP Choice, and/or Keystone First Community HealthChoices. Please use this Application Checklist as a fax cover sheet. Fax all applicable items on the checklist to the Credentialing department at. 1-877-759-6221.Third-Party Liability (TPL) Third-party liability (TPL) is when the financial responsibility for all or part of a member's health care expenses rests with an individual entity or program (e.g., Medicare, commercial insurance) other than Keystone First. Coordination of benefits (COB) is a process that establishes the order of payment when an ...Keystone First fully supports and encourages all providers to follow the CDC's recommendation of how healthcare providers can prevent the spread of antibiotic resistance by: Only prescribing antibiotic therapy when it is likely to be beneficial to the patient. Using an agent targeting likely pathogens.Provider webinars. Tobacco cessation training. We are confident that you will find these courses beneficial and useful. Please direct all feedback to [email protected]. We look forward to hearing from you. Information and Resources for Medical Providers to take continuing medical education (CME) courses online.The online prior authorization submission tutorial guides you through every step of the process. You can also call 1-800-588-6767 for help. Pharmacy Prior Authorization. OB: 1-844-688-2973. Providers are responsible for obtaining prior authorization for services prior to scheduling. Please submit clinical information, as needed, to support medical necessity of the request. Requests will not be processed if missing clinical information or CPT and ICD-10 codes. To: Keystone First and Keystone First Community HealthChoices Providers . Date: August 22, 2023 . Subject: DHS updated Sterilization Consent Form (MA 31) DHS recently published Medical Assistance Bulletin (MAB) 01-23-21, to inform providers that an updated version of the Sterilization Consent Form (MA 31) is available for use. Together, Keystone First and our providers are committed to advocating health and safety in the communities we serve. We designed Healthy Families, Safe Communities as a resource center for members and providers. Find a Provider. You will have to choose one of the network providers listed in this directory to be your primary care provider (PCP). Generally, you must get your health care coverage from your PCP. Check with your PCP before going to see a specialist. Search for the kind of provider you need. Find a PCP, specialist, hospital, or other facility.P.O. Box 7316 London, KY 40742. Keystone First will send the Health Care Provider a letter acknowledging Keystone First’s receipt of the request for a Second Level Appeal Review within ten business days of Keystone First’s receipt of the request from the Health Care Provider.Provider Manual and Forms. 2023 Keystone First Provider Manual updates (PDF) Download the 2023 Provider Manual (PDF) Non-participating provider emergency services payment guidance (PDF) Discharge planning guide (PDF) View/print sections of the Provider Manual. Appendix (PDF) Claims filing instructions (PDF) Domestic violence - resources for ...If you’re a resident of Pennsylvania, you’ll know that electricity rates can vary widely depending on your location and provider. However, finding the lowest electric rates in PA i...Keystone First, coverage by Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania. This site contains links to other Internet sites. Keystone First is not responsible for the content of these sites.Find a provider . Member portal login . Providers. Provider Homepage Join our network Find a provider ... If you have questions about the member portal or Keystone First, call Member Services at 1-800-521-6860 (TTY 1-800-684-5505). Members. Find a Doctor, Medicine, or Pharmacy; Member portal; View your benefits; Getting care; Counseling services. Tobacco cessation counseling services are covered for all members when provided at a facility approved by the Pennsylvania Department of Health. Members may access this service without referral or authorization. • 70 counseling sessions per calendar year. A counseling session is defined as a 15-minute, face-to-face ... Opens a new window. Claims processing address: Keystone First. Claim Processing department. P.O. Box 7115. London, Kentucky 40742. June 1, 2020, new and current explanation of benefit (EOB) codes (PDF) Opens a new window. Supplemental billing information for modifiers 25 and 59 (PDF) Provider Manual | May 2023. Primary Care | Specialist | Ancillary | Hospital . KF_232717100-1 Find a provider; Participants portal login; For Providers. Providers Homepage; Join our network; Find a doctor, drug, or pharmacy; Provider manual and forms; Pharmacy …Keystone First has developed the Condition Optimization Program (COP) to compensate providers for completing the essential, administrative activities that help to validate encounter data and for encouraging our members to routinely visit their primary care provider (PCP). Keystone First has developed the Condition Optimization Program …Learn about our program developed to assist your practice in engaging and managing the healthcare needs of chronically ill Keystone First members. Quick Contact Information. …www.keystonefirstpa.com Providers Claims and Billing Claims filing instructions or . www.keystonefirstchc.com Providers Claims and Billing Claims filing guide for medical providers. If you have any questions regarding this notice, please contact your Account Executive or Provider Services at 1-800-521-6007.Provider webinars. Tobacco cessation training. We are confident that you will find these courses beneficial and useful. Please direct all feedback to [email protected]. We look forward to hearing from you. Information and Resources for Medical Providers to take continuing medical education …February 15, 2024 (PDF) View our provider webinars, including patient-centered medical home.The health care provider must have one or more offices in the Keystone First network – Bucks, Chester, Delaware, Montgomery and Philadelphia Counties. Exceptions are made based on contiguous areas or network need. The following organizations are recognized by Keystone First for purposes of verifying specialty board certification:Keystone First is dedicated to providing the most comprehensive, outcomes-driven health solutions for our members. Part of this approach means making it a priority to reduce unnecessary variations in care. We've used the latest scientific evidence and research to create the clinical policies, which represent the latest in current professional ...Keystone First fully supports and encourages all providers to follow the CDC's recommendation of how healthcare providers can prevent the spread of antibiotic resistance by: Only prescribing antibiotic therapy when it is likely to be beneficial to the patient. Using an agent targeting likely pathogens.P.O. Box 7316 London, KY 40742. Keystone First will send the Health Care Provider a letter acknowledging Keystone First’s receipt of the request for a Second Level Appeal Review within ten business days of Keystone First’s receipt of the request from the Health Care Provider.In order to bill Keystone First electronically, you will need to contact your vendor and/or clearinghouse to request for our payer ID be added to your list of payers. This should be sufficient to get you started. If you have any questions or experience problems you can contact our EDI technical support hotline: 1-877-234-4271, press 4, or you ...February 15, 2024 (PDF) View our provider webinars, including patient-centered medical home.If Provider have questions Services about department this communication, at 1- 800- 521-6007. contact your Provider Account Executive or. 80375. G0480-. 80377. Drug(s) or substance(s), definitive, qualitative or quantitative, not. otherwise. specified.Provider webinars. Tobacco cessation training. We are confident that you will find these courses beneficial and useful. Please direct all feedback to [email protected]. We look forward to hearing from you. Information and Resources for Medical Providers to take continuing medical education (CME) courses online.
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Community Account Executive Director: Kim Beatty, 1-215-863-6614. 1-267-835-6189 (cell) [email protected]. Community physicians. Philadelphia College of Pinnacle Physicians Group, LLC • Oxford Circle Family Medicine. Osteopathic Medicine (PCOM) • Dr. Murray Brand and Associates • Arrow Family Medicine.Feb 15, 2024 · February 15, 2024 (PDF) View our provider webinars, including patient-centered medical home. Dentist. Oral surgeon. Physicians (DOs and MDs) Podiatrist. Registered dietician. Select a credentialing process. CAQH credentialing. Paper credentialing. See additional …The updated 2023 Keystone First Provider manual is now available online. May 16, 2023. Keystone First is pleased to announce the availability of the 2023 Provider Manual. Examples of updates and changes include topics such as: Prior Authorization Lookup tool: Added information required to properly assess a Provider’s request for prior ...Zocdoc is a free online service that helps patients find Keystone First Eye Doctors and book appointments instantly. You can search for Keystone First Eye Doctors by symptom or visit reason. Then, choose your location. Based on that information, you’ll see a list of providers who meet your search criteria, along with their available ...These updated and enhanced remark codes will provide better clarity for you in identifying the specific payment reason. Thank you for your participation in our network and the dedicated care you provide to our Members and Participants. If you have any questions regarding this notice, please contact Provider Services at 1-800-521-6007. Pharmacy forms. Physician certification for abortion (PDF) Prior authorization form (PDF) Provider change form (PDF) Provider claim refund form (PDF) Recipient statement form (PDF) Recipient statement form under age 18 (PDF) Sterilization consent form (PDF) View and print sections of the provider manual and access provider forms. OB: 1-844-688-2973. Providers are responsible for obtaining prior authorization for services prior to scheduling. Please submit clinical information, as needed, to support medical necessity of the request. Requests will not be processed if missing clinical information or CPT and ICD-10 codes. Quit smoking. Keystone First's tobacco cessation program helps members quit smoking or using other tobacco products. Health education programs. Keystone First has developed health education programs that focus on early detection, preventive care, healthy behaviors, and overall personal health awareness. Gym Membership – Focus on Fitness.For Providers. → Pharmacy services. If you have any questions regarding this notice, please contact Pharmacy Services: Plan Name Telephone Number . Keystone First . 1-800-588-6767 . Keystone First Community HealthChoices . 1-866-907-7088Prior authorization process. Your PCP or other health care provider must give Keystone First information to show that the service or medication is medically necessary. Keystone First nurses review the medical information. The nurses use clinical guidelines approved by the Department of Human Services to see if the service or medication is ...2022-2023 Flu Vaccination. Your strong recommendation is a critical factor in whether your patients get vaccinated. In preparation for. the onset of the 2022-2023 flu season, while still facing COVID-19, we are asking you to encourage your Keystone First/Keystone First CHC patients to get their flu shot.Feb 15, 2024 · February 15, 2024 (PDF) View our provider webinars, including patient-centered medical home. Keystone First Community HealthChoices knows the importance of establishing and maintaining relationships with area physicians, hospitals, and health care providers. Through our partnership with participating providers like you, we aim to give our participants the quality health care they deserve. New: Important network information (October 2023)(Click on the county below to find a provider near you. You can make your own appointment with a provider.) Your PCP can also help you get the treatment you need.Connections — our provider newsletter. Spring 2024 (PDF) Archive: 2023. 2022. 2021. 2020. Recent and Archived letters to Keystone First Participating providers. Current year listed by date and archived by year.Coronavirus (COVID-19) Keystone First is committed to offering a dental benefit program that ensures access to high quality oral health care. To realize our commitment to our members, providers and stakeholders, Keystone First is contracting directly with dental providers to foster closer relationships between the health plan, our participating ...If you have any questions or need help finding a provider, call Member Services at 1-800-450-1166 (TTY 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31. We can also mail a hard copy of the provider directory to you. Y0093_001_232792656. …Keystone First 200 Stevens Drive Philadelphia, PA 19113. Driving directions. By telephone. Main telephone number 1-215-937-8000. Member Services 1-800-521-6860 TTY: 1-800-684-5505 Representatives are available 24 hours a day, 7 days a week. Provider Services 1-800-521-6007 Representatives are available 24 hours a day, 7 days a week. By emailSpecialist office visits. Keystone First covers your visits to specialists in our network. There is no limit to how many times you may see the specialist. Remember to get a referral if one is needed from your PCP before you visit a specialist. There may be co-pays for your visits to some specialists. Please see the member co-payment schedule (PDF)..
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