BJC Health and Cox HealthPlans (Cox) have partnered to create a flexible solution that allows employers to supplement their existing third-party administrator (TPA) relationship and provider network (which may exclude BJC HealthCare and WashU Medicine) by creating a new direct access model to BJC facilities and providers and WashU providers called “BJC–WashU Direct.”
This approach enables your employee health plan members to preserve in-network access to one of the country’s leading health systems.
How the Solution Works
- Employer retains its current TPA
- Employer enters into a simple, additional TPA agreement with Cox HealthPlans
- Cox issues ID cards for in-network access to BJC and WashU to supplement other TPA’s network
- Cox processes claims under an in-network benefit level for covered services provided by BJC and WashU
- Eligibility, claims, and accumulators are electronically coordinated between existing TPA and Cox (collectively, “TPAs”)
- Dedicated implementation teams coordinate set up of data exchange and administrative workflows between TPAs
- Collaborative implementation minimizes changes and complexity for employers and brokers
- Flexible reporting and administrative support throughout the relationship
Key Benefits
- Maintain your existing TPA relationship
- Unique model created for simple TPA relationship for access to BJC and WashU direct network
- Preserve in-network access to BJC and WashU for your employee health plan participants
- Preserve access to highly-competitive reimbursement rates with BJC and WashU through the new Cox TPA arrangement
- Minimize disruption to employees, dependents and human resources team
- Coordinate administration through an integrated solution