DRAFT

Cayuga Area Plan, Inc.

Cayuga Area Preferred, Inc.
CAYUGA AREA PREFERRED/PLAN CONTRACT ABSTRACT
Name:
Type:
Employers covered:
Covered lives:
Service area covered:
Administrator:
Insurer:
CAP contract date:
Term:
Fees effective:
Notice date:
Reimbursement type:
E& M
Procedural
Chemo Admin/Infusion
Anesthesia (per unit)
Injectable Drug
Vaccines
Lab
Bundling/Claim Edits

Excellus Health Plan, Inc. (BlueCross BlueShield)

Commercial Products (Traditional Indemnity, HMO, Point of Service,
PPO, EPO)
individuals, small and large groups
27,000
CAP service area (Tompkins + surrounding zips)
Excellus
Excellus
1/1/2007
Through 12/31/2017**
1/1/2015 12/31/2015*
1 year
discounted fee for service
2014 RBRVS Allowed 59.5406
2014 RBRVS Allowed 72.2152
2014 RBRVS Allowed 80.4005
$90.36* per unit
ICORE Drug updates quarterly
2015 Updates: 2/15/15, 5/15/15, 8/15/15, 11/15/15
Wholesale Acquisition Cost + 5% updated bi-monthly.
2013 updates: 1/1/15, 3/1/15, 5/1/15, 7/1/15, 9/1/15, 11/1/15
Lab reimbursement is designed to be roughly equivalent to100% of
2014 Upstate Medicare
McKesson's ClaimCheck

**Future years: Reimbursement totals adjusted according to the change in a Medical CPI-U established in September of
each year.

Late payments:
Benefit design:
Gatekeeper:
Precertification:
Utilization review:
Credentialing:
Contacts:
claims admin:
contract terms

101 Dates Drive

Ithaca, New York 14850
607.274.4616 phone
607.274-4587 fax

per NYS law

Varies by Plan
Yes for HMO products
some
Y
Excellus (CAQH)
Provider Service at 1.800.920.8889
CAP 607.274.4616

A physician-hospital partnership between

Cayuga Area Physicians Alliance
and Cayuga Medical Center at Ithaca

DRAFT

Cayuga Area Plan, Inc.

Cayuga Area Preferred, Inc.
CAYUGA AREA PREFERRED CONTRACT ABSTRACT
Name:
Type:
Employers covered:

Excellus Health Plan, Inc. (BlueCross BlueShield)

RMSCO (self-insured)
medium to large groups

Service area covered:

Administrator:
Insurer:
CAP contract date:
Term:
Fees effective:
Notice date:
Reimbursement type:
E&M
Procedural
Chemo Admin/Infusion
Injectable Drug

Lab
Anesthesiology (per unit)

CAP service area (Tompkins + surrounding zips)

Excellus
Excellus
12/18/2002
Through 12/31/2017
1/1/2015 12/31/2015*
1 year
discounted fee for service
2013 Upstate Medicare RVUs x 72.5464
2013 Upstate Medicare RVUs x 86.4657
2013 Upstate Medicare RVUs x 96.2666
ICORE quarterly updates
2015 Updates: 2/15/15, 5/15/15, 8/15/15, 11/15/15
Wholesale Acquisition Cost + 5% updated bi-monthly
2015 updates: 1/1/15, 3/1/15, 5/1/15, 7/1/15, 9/1/15,11/1/15
100% of 2014 Upstate Medicare
$95.00 per unit*

Bundling/Claim Edits

McKesson's ClaimCheck

Vaccines

*Future years: Reimbursement totals adjusted according to the change in a Market Rate established in September of each
year.

Withhold, risk share:

Incentive:
Late payments:
Benefit design:
Deductible
copay
in network
out of network

none
none
per NYS law

Gatekeeper:
Precertification:
Utilization review:
Credentialing:
Contacts:
claims admin:
contract terms:

No
some
Y
Excellus (CAQH)

101 Dates Drive

Ithaca, New York 14850
607.274.4616 phone
607.274-4587 fax

variable
variable
variable
variable

Provider Service at 1.800.920.8889

CAP 607.274.4616

A physician-hospital partnership between

Cayuga Area Physicians Alliance
and Cayuga Medical Center at Ithaca