Anthem Blue Cross Amends Physician Contracts to Include Individual/Exchange Product; Resources/Assistance Available to SFMS Members November 6, 2012 News, Payment, Physician Resource payor contract, physician contract agreement, Anthem Blue Cross, Blue Cross opt out, managed care contract 0 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 SFMS/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 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. SFMS/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. Individual/Exchange Network Opt-Out Physicians can opt out of the individual/exchange network by notifying 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. Sections VI and VIII of the contract amendment provide instructions for physicians who wish to opt out of the individual/exchange network. 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. Physician Status Inquiries 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. Assistance with Anthem Blue Cross Contracts SFMS members can receive one-on-one assistance by contacting CMA staffers Mark Lane (916) 551-2865 or Jodi Black (916) 551-2863. Health Plan Contract Analyses As part of your member benefit, SFMS members enjoy free access to objective analyses of several health plan participating provider contracts. While these analyses are not intended to be exhaustive, they are designed to draw a physician's attention to issues which may warrant further inquiry or clarification. Log into the SFMS website to view/download the Blue Shield Provider Agreement analysis, updated in September 2012. To access the member-only section for the first time, please use your license number as the username and the first name initial and full last name as the password. For example, Dr. John Doe’s password would be “JDoe.” Click here to view analyses for Anthem Blue Cross of California Prudent Buyer Plan, Health Net, and United Healthcare. Please note SFMS/CMA is currently updating contract analyses for each of the California major health plans. Updated analyses will be posted on the SFMS website when they are available. Step-by-Step Guide to Payor Contract Negotiation SFMS/CMA have developed a step-by-step guide to assist physician members through the contract evaluation and negotiation/renegotiation process. Click here to view/download the free membership-only guide after logging into the SFMS website. Member Helpline with Health Plan Contracting Issues SFMS members are encouraged to contact our complimentary member reimbursement help line at (888) 401-5911 or economicservices@cmanet.org for personalized assistance with contracting issues. Comments are closed.
