Blue Shield makes positive changes to reimbursement policy for physicians treating out-of-network exchange PPO patients

Effective with September 14, 2014 dates of services, Blue Shield will implement changes to the out-of-network claims payment process and will now reimburse providers directly when PPO exchange/mirror product patients are seen out of network.

Physician Advocate Tip of the Month: Be aware of the off-exchange products that utilize Covered CA plan networks

Every plan offered in Covered CA must also be offered outside of Covered CA, using the same network. If you see these product names on the ID card, it indicates the patient only has access to the Covered CA network.

Physician Advocate Tip of the Month - Surviving the first month of Covered California

On January 1, 2014, California's health benefit exchange, Covered California, began providing health coverage to more than 400,000 patients statewide. It is critical that physicians and their staff know what to expect.