Keystone 65 Select Network (formerly the Medicare Limited Network)

Eligibility requirements are subject to change.

For Ancillary Provider Participation

In order to be eligible to participate in the Keystone 65 Select network, an ancillary provider must meet the following requirements:

• An ancillary provider must currently be participating in our Medicare Advantage HMO network.
• An ancillary provider cannot be employed by, or owned by, a hospital that is not participating in the Keystone 65 Select network.

For Professional Provider Participation

In order to be eligible to participate in the Keystone 65 Select network, a professional provider must meet the following requirements:

• A professional provider must currently be participating in our Medicare Advantage HMO network.
• A professional provider must either have admitting privileges at a hospital that is participating in the Keystone 65 Select network or provide IBC with a copy of a coverage agreement with another physician in their same or similar specialty who is participating in the Keystone 65 Select network and has admitting privileges at a hospital participating in the Keystone 65 Select network.
• If a primary care physician’s (PCP) current capitation site is not participating in the Keystone 65 Select network, the PCP must have a secondary capitation site that is participating in the Keystone 65 Select network.
• A professional provider cannot be employed by, or have their practice owned by, a hospital that is not participating in the Keystone 65 Select network.
• The specialties below do not require admitting privileges at a hospital that is participating in the Keystone 65 Select network and are therefore considered participating:
  • Anesthesiology
  • Dermatology
  • Radiology
  • Pathology
  • Podiatry
  • Chiropractic
  • Preventive medicine
  • Emergency medicine
  • Registered dietitian
  • Certified registered nurse (nurse practitioner)
  • Optometry
  • Audiology
  • Physical therapy
  • Registered nurse
  • Speech therapy
  • Occupational therapy
  • Certified registered nurse anesthetist
  • Certified registered nurse
  • Clinical genetics

How to Participate

If you are a professional provider and are currently eligible to participate in the Keystone 65 Select network, but do not meet all of the requirements above, you can do one of the following:

• Obtain admitting privileges at a hospital that is participating in the Keystone 65 Select network. Complete the Keystone 65 Select Network Hospital Privileges Attestation form below, and return it to your Network Coordinator; or
• Obtain a coverage agreement with another physician in your same or similar specialty who is participating in the Keystone 65 Select network and has admitting privileges at a hospital that is participating in the Keystone 65 Select network. Complete the Keystone 65 Select Network Hospital Privileges Attestation form below and return it to your Network Coordinator.

Lastly, if you are a PCP and one or more of your existing capitation sites is not participating in the Keystone 65 Select network, you are required to select a secondary in-network capitation site for all members who are enrolled in the new Keystone 65 Select HMO. Please refer to the document below which lists the capitation sites that are participating in the Keystone 65 Select network. If your existing capitation site is not on this list, contact your Network Coordinator to select a secondary in-network capitation site.

If you have any questions, please contact your Network Coordinator.

Keystone 65 Select Network Capitation Sites

Keystone 65 Select Network Hospital Privileges Attestation Form