Blue Shield Launched Recontracting Initiative February 13, 2012 CMA, Physician Resource Blue Shield, physician contract 0 Blue Shield of California is in the process of re-contracting with physicians across the state and San Francisco is affected by this initiative. Notices to physicians were mailed on January 27. Blue Shield states the reason for the recontracting initiative 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 will be offering various tiered networks based on price point in anticipation of California’s health insurance exchange, a key feature of the federal health reform law. Physicians are under no obligation to participate in any of these products. There are no fee schedule changes at this time, other than for Medicare lines of business. The cover letter that accompanied the new contract asks that physicians review, sign and return the new agreement to Blue Shield by February 17. However, Blue Shield has assured CMA that failure to return the new agreement will not affect a physician’s participation status with Blue Shield. To assist physicians, CMA has completed an analysis of the new Blue Shield contract, which is available to CMA members at http://www.cmanet.org/ces. Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any contract for the delivery of medical services or the associated management and administrative services. For additional information on evaluating and negotiating complex managed care contracts, see CMA’s contracting toolkit, Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations – A Focus on Payor Contracting. Physicians with concerns about the new contract terms are encouraged to contact Blue Shield Provider Services at (800) 258-3091. If you are a SFMS member requiring assistance with payor issues or questions, please contact the CMA Reimbursement Helpline at (888) 401-5911 or economicservices@cmanet.org. Comments are closed.
