Thursday, December 14, 2017

OCMA Blog

Anthem Blue Cross Amending Some Physician Contracts to Include Individual/Exchange Product

On October 24, Anthem Blue Cross sent a notice to 8,345 physicians who are part of the Blue Cross Select PPO network announcing its intent to participate in the California Health Benefit Exchange, the state's new insurance marketplace called for under the Affordable Care Act.  Beginning in 2014, individuals and small business will be able to purchase health insurance using tax subsidies and credits from the exchange.

 

According to the notice, Blue Cross will be creating a new provider network called the "Anthem Individual/Exchange Network," which will serve both individuals who purchase coverage through the exchange and individuals who purchase coverage from Anthem Blue Cross in the individual market outside of the exchange. In other words, the fee schedule would apply to all individual business, whether bought on or off of the exchange. 


Blue Cross has clarified for the California Medical Association (CMA) that this fee schedule change will not apply to Small Business Health Options Program (SHOP) business purchased through the exchange.


It's important to note that the letter also states that Blue Cross is amending the physician's Blue Cross Prudent Buyer Agreement to automatically include the new individual/exchange network, effective January 1, 2014. The new fee schedule associated with this product was included with the notice.

CMA has been actively working with exchange stakeholders to address significant concerns regarding the exchange grace period, monitoring of network adequacy and clinician-level performance measurement in qualified health plans offered in the exchange. (Click here for more information about contracting with exchange plans.)  


Though not mentioned in the Blue Cross cover letter, Sections VI and VIII of the enclosed amendment provide instructions for physicians who wish to opt out of the individual/exchange network. Physicians who do not wish to participate in this network must notify Blue Cross of their intent to opt out by December 31, 2012. Opt out notices should be in writing and sent via certified mail, return receipt to the address specified in Section VI of the amendment.


CMA is working with Blue Cross to obtain additional clarification on the amendment and will provide updates as they are received.

Please note that a small subset of Select PPO Network physicians did not receive the October 24 notice automatically opting them into the individual/exchange network. This subset of physicians received a notice from Blue Cross dated October 9 regarding fee schedule reductions. Physicians who choose to discontinue participation in the Select PPO network at the reduced rates have until December 14 to notify Blue Cross in writing.

As always, physicians are encouraged to carefully review all proposed amendments to payor contracts. You do not have to accept substandard contracts that are not beneficial to your practice.


Physicians who did not receive a letter and are unsure whether they are affected by this change or those who have general questions about the amendment can contact Blue Cross's Network Relations Department at (855) 238-0095 or networkrelations@wellpoint.com.


OCMA/CMA members can contact the CMA reimbursement helpline: (888) 401-5911 or economicservices@cmanet.org


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