Saturday, December 16, 2017

OCMA Blog

Blue Shield Recontracting Effort Expanding to Orange County

Earlier this year, Blue Shield began recontracting with physicians across the state. The California Medical Association (CMA) has learned that physicians in Orange County will be next to see the new contracts.

Blue Shield has assured CMA that if a physician chooses not to sign the new agreement, his or her participation status with Blue Shield will not be affected.

The reason for the recontracting initiative, according to Blue Shield, is twofold: 1) Blue Shield has not done a large scale recontracting with physicians in over a decade, so the new contracts will allow Blue Shield to ensure consistency and compliance with new laws and regulations; and 2) Blue Shield is offering various tiered networks based on price point in anticipation of possible participation in California's Health Benefit Exchange.    

CMA continues to work 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.

Exhibit A of the new Blue Shield contract allows physicians to designate which products they are willing to participate in by product type.

While Blue Shield did update its fee schedule statewide on July 1, there is no fee schedule change associated with this recontracting initiative, with the exception of the Direct Contract HMO Medicare Advantage product.

Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any new contract and new product types. To assist physicians, CMA has completed an  analysis of the new Blue Shield contract, which is available to members in CMA's online resource library at  http://www.cmanet.org/resource-library.

For additional information on evaluating and negotiating complex managed care contracts, see CMA's contracting toolkit, "Taking Charge: A step by step guide to evaluate and prepare for negotiations with managed care payors."The toolkit is also available free to members in CMA's resource library.

The notice  directs physicians with questions about the new contract terms to contact Blue Shield Provider Services at (800) 258-3091.

Questions: CMA at (888) 401-5911 or economicservices@cmanet.org.


Home   |   About Us   |   Membership   |   For Physicians   |   News   |   For Patients   |   Advocacy   |   Events
Copyright (c) 2017 Orange County Medical Association