New Anthem Blue Cross Exchange Addendum: What Physicians Need to Know April 18, 2014 Covered California, Physician Resource, Practice Management Anthem Blue Cross, Anthem Exchange Addendum, Covered California, Anthem 0 Anthem Blue Cross recently notified over 11,000 practices who are currently participating in its individual/exchange network of a contract addendum that will become effective July 1, 2014. The amendment only applies to physicians who are currently participating in the Anthem Blue Cross individual/exchange network. According to the notice, the addendum contains new regulatory requirements. While many provisions are requirements of Covered California, SFMS/CMA has concerns with certain provisions that appear to be beyond the scope of regulatory requirements, including: Section 7 contains a broad requirement that physicians participate in any existing or future quality initiatives of Anthem or Covered California. While Covered California does require qualified health plans (QHPs) to report on a number of quality measures, SFMS/CMA is concerned that this broad provision could require physicians to comply with overly burdensome and/or costly requirements in order to meet current or future quality program criteria. Additionally, there are no exceptions if a physician is unable to comply with or report various quality or other performance measures. Section 12 removes a participating physician’s ability to opt out of the individual/exchange product without affecting the underlying Prudent Buyer contract. Effective July 1, the only option for physicians who wish to opt out of the individual/exchange product is to terminate the underlying Prudent Buyer PPO agreement. A provision in Section 10 allows Anthem to share providers’ contracted rates with Covered California. While Covered California does require QHPs to provide access to provider rates as of July 2014, SFMS/CMA has expressed concern with Covered California about the intended uses of this data. Physicians have the right to opt out of the Anthem exchange product without affecting the underlying Prudent Buyer PPO contract if Anthem receives notice by June 30. If you do not wish to participate in the individual/exchange product, you can opt out by providing 90 days written notice, which should be sent via certified mail with return receipt, to: Anthem Blue Cross Prudent Buyer Plan Contract Processing Attn: Individual/Exchange Contract Processing Mail Station 8A P.O. Box 4330 Woodland Hills, CA, 91365-4330 Please cc CMA on any opt-out notices submitted to Anthem at the following address: California Medical Association Center for Economic Services 1201 J Street, STE 200 Sacramento, CA 95814 Physicians are as always urged to carefully review and assess the impact any contract changes or addendums will have on their practices. Questions and concerns about the Anthem exchange addendum should be directed to the Anthem Blue Cross Network Relations at (855) 238-0095 or networkrelations@wellpoint.com. Comments are closed.
