Overview

What is happening to Patrius Health’s Medicare Advantage Plans?
Patrius Health’s Medicare Advantage Plans will not be offered in 2027. Coverage for all Patrius Health members will end on December 31, 2026. 

When will this take effect?

• Member coverage ends on December 31, 2026 (11:59 p.m.)
• Plans no longer available as of January 1, 2027

Why is Patrius Health member coverage ending?
The Medicare Advantage market is highly competitive and continues to face regulatory challenges and financial pressures. These conditions make it challenging for Patrius Health to sustainably offer a competitively priced Medicare Advantage product.

Member Coverage and Access

Will members still have coverage through the end of 2026?
Yes. Members will continue to have full access to covered benefits, including in-network providers, through December 31, 2026, as long as they remain enrolled and meet premium requirements.

Can members continue seeing providers through the end of 2026?
Yes. Members may continue receiving covered services with in-network providers through the end of the year.

What happens to services provided on or after January 1, 2027?
Services will not be covered under Patrius Health after December 31, 2026. Claims for services rendered on or after January 1, 2027, will be processed based on the member’s new coverage. 

Provider Network and Contracts

Will providers remain in-network through 2026?
Yes. Existing contracts and network participation remain in effect through December 31, 2026.

What happens to provider agreements?
The Patrius Health-related provider agreement will terminate effective December 31, 2026.

Will new providers be added to the network in 2026?
No. The network is closed to new providers for the remainder of 2026. 

Claims and Billing

Are there any changes for submitting and processing claims for 2026 dates of service?
No. Continue to submit claims for services provided on or before December 31, 2026, using existing processes.
 
What are the timely filing deadlines?

• Claims must be filed within 15 months from the date of service.
• Providers are encouraged to submit all claims and corrected bills by December 31, 2027, to avoid delays in processing and payment.
• Any provider appeals (plan payment disputes) must be submitted prior to March 31, 2028.

Operations and Workflows

Will eligibility, prior authorization and pre-service review processes change in 2026?
No. All existing processes will remain the same through December 31, 2026.

Will provider portal access remain available?
Yes. Provider portal access for Patrius Health claims and medical records through myBlue Provider will remain available through March 31, 2028.

Will providers still need to submit medical records?
Yes. Continue responding to medical record requests for claims, risk adjustment and coding reviews as usual. Check myBlue Provider for any requested medical records and respond by the due date on the request. 

How long do providers need to retain claims and medical records?
Per the network agreement, providers must retain all claims and medical records, including documentation supporting billing and diagnosis coding, for at least 10 years after termination or until any audit (including RADV audits) is complete, whichever is later.

Incentive Programs and Reporting

Will provider incentive programs continue in 2026?
Yes. Incentive programs, reporting and payment schedules will continue for the remainder of 2026.

Will providers still have attributed members?
Yes. Attribution and related reporting (e.g., care gaps, provider insights) will continue through the end of 2026.

Support and Contact Information

Who should providers contact with questions?
Call Patrius Health provider services at 1-888-949-2352 or the member services number on the back of your patients’ Patrius Health identification card.

Who should providers contact for continuity of care questions?
Contact Patrius Health provider services for assistance with transition-related needs.