High Performance Network

 

Dear Valued Provider:

The information below provides you with salient changes regarding the 2020 High Performance Network program. Every year, AvMed selects specialties to be profiled using its quality and/or cost efficiency criteria and methodology. Through this process, AvMed recognizes physicians who consistently meet or exceed our performance criteria. We understand that not all physicians will achieve the HPN designation; however, AvMed acknowledges the value of all physicians that meet NCQA credentialing standards for network participation. As our trusted network partner, we encourage you to become familiar with this information, as it affects you and the Medicare AvMed members you serve.

Medicare Member Cost Share Responsibilities:

Starting January 1, 2020, Medicare Advantage members who visit AvMed participating specialty physicians will incur the following copayments:

2020 MEDICARE HIGH PERFORMANCE NETWORK (HPN) DESIGNATION BENEFIT & CO-PAYMENT MATRIX
MEDICARE CHOICE (HMO)*
MEDICARE CHOICE (HMO)*
MEDICARE CIRCLE*

* Co-payment rules also apply to Physician Assistants and ARNPs.

MEDICARE MEMBER PLAN BY COUNTY
IN HPN NETWORK (LOWER PLAN CO-PAYMENTS APPLY)
OUT OF HPN NETWORK (HIGHER PLAN CO-PAYMENTS APPLY)
ALL SPECIALISTS (SAME PLAN CO-PAYMENTS APPLY)
DADE COUNTY AVMED MEDICARE
$0
$25
$0
BROWARD COUNTY AVMED MEDICARE
$10
$20
$10

The HPN symbol (Δ) is noted in AvMed’s online Medicare provider directory next to the name of each HPN designated physician.

Selected Specialties for 2020 High Performance Network profiling:

  • Cardiology*
  • Endocrinology
  • Gastroenterology*
  • General Surgery*
  • Interventional Cardiology*
  • Nephrology*
  • Neurology*
  • OB/GYN*
  • Oncology*
  • Orthopedic Surgery*
  • Otolaryngology*
  • Pain Management*
  • Pulmonology
  • Rheumatology
  • Urology*

*Denotes specialties using only cost efficiency criteria.

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