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WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupCOMMERCIALAetnaAetna WellStar Employee PlanAlaMedHMO/PPOWellStar Employee Plan/ BHWorkers CompYesYesNoYesYesYesYesYesNoYesYesNoAlliant Health Plans, Inc.PPOYesNoOnly NFRYes(Excludes SRE, SYL,AMC, AMSC physicians)America's Choice Provider NetworkAnthem / Blue Cross Blue Shield ofGeorgiaAnthem / Blue Cross Blue Shield ofGeorgiaBeech Street (under MultiplanAgreement)CignaCoastalComp Health NetworkCompCare Network / Key RiskCorvelCorvelKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective datePPO/Workers CompNoNoYesYes(Excludes Cobb,Douglas, Kennestone,Paulding, Windy Hilland West GAphysicians)Commercial/Indemnity/ BHYesYes excl. BHYesYesBlue High Performance Network(Blue HPN)NoNoNoNoPPO/Workers CompYesYesYesYesYesYesYesYesNoNoNoNoNoNoYesNoOnly NFRYesOnly AMC/AMCS/NFR/SREOnly AMC/AMCS/NFR/SRENoNoOnly AMC/AMCS/SREOnly AMC/AMCS/SRECommercial - (does not includeLocal Plus)Workers CompWorkers CompWorkers CompCommercial1Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupEvolutionsFirst Health/CoventryFirst Health/CoventryGalaxy Health NetworkHealth Management NetworkCommercialPPOWorkers CompCommercialPPONoYesYesNoNoNoYesNoNoNoOnly AMC/AMCS/SREYesYesYesNoOnly AMC/AMCS/SREYesYesOnly AMC/AMCS/SREOnly AMC/AMCS/SREHealth One AlliancePPOYesNoOnly NFRYes(Excludes SRE, SYL,AMC, AMSC physicians)Heritage Summit HealthcareWorkers CompCommercial(Excludes HMOx)NoNoNoOnly AMC/AMCSYesYesYesYesHumanaYesHumana MilitaryTricare PrimeYesNoYes - AMC/AMCS/SRE onlyHumana MilitaryTricare SelectYesYesYesNoNoYes(except SNF)YesYesYesNoNoYesYesYesYesYesYesUrgent Care onlyYesKaiser PermanenteKaiser Permanente PHCSDual Choice PPOYesMulti PlanMulti PlanNova Net (Special Net)PPO/AutoWorkers CompPPO/Auto/Workers CompYesYesYesKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective dateYes2Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAOnly AMCOnly SRE/SYLNoYesYesYesYesYesYesYesNoNoPPONoNoOne CallWorkers CompNoOne Call f/k/a Align NetworkWorkers CompNoPrime Health ServicesPrivate Healthcare Systems (PHCS)(under Multiplan Agreement)Private Healthcare Systems (PHCS)(under Multiplan Agreement)Private Healthcare Systems (PHCS)(under Multiplan Agreement)PPO/Auto/Workers CompYesPPOYesNoOnlyPhysical TherapyYesYes(except SNF)Workers Comp/AutoYesPractitioner &/or Ancillary OnlyNoPPOStarCareThree RiversPPOCommercialUnited HealthcareCommercialKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective dateWellStar MedicalGroupYes(Excludes Cobb,Douglas, Kennestone,Paulding, Windy Hilland West GAphysicians)NoNPPN/Plan Care America (Stratose)Provider SelectAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveYes(Excludes AMCS)NoNoYes(Excludes AMCS)NoYesNoTerm eff 10/3/2021NoYesNoTerm eff 10/3/2021NoOnly AMC/AMCS/SRENoTerm eff 10/3/2021YesYes(Excludes AMCS, Cobb,Douglas, Kennestone,Paulding, Windy Hilland West GAphysicians)NoYesNoTerm eff 10/3/20213Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductUSA Managed Care OrganizationPPO/Workers Comp/AutoVA CCN/OptumCommunity Care NetworkVeterans Evaluation ServicesDiagnosticsKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective dateCobbDouglasKennestonePauldingWindy HillNoYeseff 11/1/2021NoWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupNoYeseff 11/1/2021NoAMC/AMCS/SREYeseff 11/1/2021YesOnly AMC/AMCS/SREYeseff 11/1/2021No4Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupYesYesMEDICARE SUPPLEMENTAL POLICIESMedicare Supplemental Policies - ALLSecondary to TraditionalMedicareYesYesMEDICARE ADVANTAGE PLANS (MA)YesTerm eff 12/31/2021YesYesYesTerm eff 12/31/2021YesYesYesTerm eff 12/31/2021YesYesYesTerm eff 12/31/2021YesYesYesYesYesYesHMO / PPOPPOYesYesYesYesNoYesYesYesYesYesYesYesHMO / PPO/ D-SNPYesYesYesYesPPO/PFFSHMOHMO / D-SNPYesYesNoYesYesYesNoYesYesYesNoYesPositive Healthcare PartnersHMO/ D-SNPYesNoYesPruitt Health PremierSonder Health PlansD-SNPHMOUnited HealthcarePPO/ D-SNP /C-SNPYesYesYesTerm eff 12/31/2021YesYesYesTerm eff 12/31/2021YesYesYesTerm eff 12/31/2021YesYesNoYesYes(Excludes West GAphysicians)YesYesYesTerm eff 12/31/2021AARP Medicare Complete (UHC)HMOAetnaAnthem / BCBS Medicare AdvantageHMO / PPO/ D-SNPHMO / PPOD-SNP ActiveHMO Term eff 12/31/2021CareSourceChampVA TraditionalCigna Medicare (Healthspring)Clover Health, LLCClear Spring Health (formerly EONHealth Plan)Humana Choice and RegionalHumana Gold ChoiceKaiserPeach State (Allwell)Key:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective date5Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerWellCareKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective dateProductHMO/POS/PPO/ D-SNPCobbDouglasKennestonePauldingWindy HillYesWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupYesYesYes6Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupHEALTH INSURANCE EXCHANGE (HIE)Alliant HealthPPOYesNoOnly NFRYes(Excludes SRE, SYL,AMC, AMSC physicians)Anthem / BCBSCareSourceKaiserOscar Health PlanAmbetter (Peach State)Pathways esNoYesNoYesYesNoYesNoYesYesKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective date7Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupYesYesYesYesYesYesYesYesYesMEDICAID CMO'SAmerigroupCareSourcePeach StateKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective dateManaged MedicaidManaged MedicaidManaged MedicaidYesYesYes8Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupDIRECT PRODUCTSCity of LaGrangeDistrict 4 Health ServicesDistrict 4 Health ServicesTuberculosisBreast & Cervical CancerScreeningGeorgia Correctional HealthcareHN1 Therapy Network of GALaGrange CollegePlotkin And Sons ConsultingTroup CountyNaphCareKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective dateNoNoYesYesNoOnly SYL & SRENoYesOnly SYL & SRENoNoYes(Medicaid/PeachcareOP therapy only)YesNoYesNoOnly AMC/SRE/SYLOnly West GANoOnly West GA, SYL &SRE physiciansNoOnly NFR/SRE/SYLNoNoNoNoAMC Main CampusOnly West GANoOnly West GAYesMedicare/MedicaidNoFederal PrisonNoNoNoNo9Last Update: 11/1/2021
WELLSTAR HEALTH SYSTEM COMBINED PAYOR GRIDNovember 2021HOSPITAL ONLYPayerProductCobbDouglasKennestonePauldingWindy HillWest GAAMC Atlanta Medical CenterAMCS Atlanta Medical CenterSouth CampusNFR North FultonSRE Spalding RegionalSYL Sylvan GroveWellStar MedicalGroupBEHAVIORAL HEALTHAetna Behavioral HealthAetna WellStar Employee PlanBehavioral Health SystemCigna Behavioral HealthCigna Medicare (Healthspring)Humana BehavioralHealth/CorpHealth/LifeSynchMagellan Behavioral HealthPeach StatePeach StateUnited Behavioral HealthKey:Yes Contract/ParticipatingNo Not Contracted/Non-ParticipatingHighlighted Adding at a future time, refer to effective dateAll ProductsWellStar Employee Plan/ BHBehavioral Health PPOCommercial Behavioral HealthHMO/PPO/OAPBehavioral HealthCommercial and MedicareBehavioral HealthCommercial and MedicaidBehavioral HealthMedicaidAmbetterCommercial and MedicareBehavioral Health HMOOnly CobbOnly CobbOnly CobbNoNoNoOnly AMC/AMCSOnly AMC/AMCSOnly AMC/AMCSNoNoNoOnly CobbNoOnly AMC/AMCSYes -BH ProvidersOnly CobbOnly Cobb, Windy Hill,PauldingNoOnly AMC/AMCSYes -BH ProvidersNoOnly AMC/AMCSYes -BH ProvidersOnly CobbNoOnly AMC/AMCSYes -BH ProvidersOnly CobbOnly CobbNoNoOnly AMC/AMCSOnly AMC/AMCSYes -BH ProvidersYes -BH ProvidersOnly CobbNoOnly AMC/AMCSYes -BH Providers10Last Update: 11/1/2021
Heritage Summit Healthcare Workers Comp No No No Only AMC/AMCS Humana Commercial . Kaiser Permanente PHCS Dual Choice PPO Yes Yes (except SNF) Yes Yes Multi Plan PPO/Auto Yes Yes Yes Yes Multi Plan Workers Comp Yes Yes Yes Urgent Care only Nova Net (Special Net) PPO/Auto/Workers Comp Yes Yes Yes Yes . HEALTH INSURANCE EXCHANGE (HIE) Key .
