DMHC Investigating Anthem and Blue Shield Provider Networks June 25, 2014 Covered California, News Anthem Blue Cross, Blue Shield of California, Covered California, network adequancy, provider directories, DMHC 0 The Department of Managed Health Care (DMHC) recently began conducting a “non-routine audit” of Anthem Blue Cross and Blue Shield of California to investigate the accuracy of the plans' provider directories and identify whether either plan violated any network adequacy laws. According to the DMHC, consumer complaints about access issues for both plans prompted the investigation. Blue Cross and Blue Shield are the only two exchange plans using narrowed provider networks for their exchange and "mirror" products. The state is looking at whether the networks are too narrow in some counties, making it difficult for enrollees to find participating providers. A recent survey of California physicians found that there is also widespread confusion about exchange plan contracting amongst providers, with 80% of physicians stating they had been confused about their participation status. SFMS/CMA has urged Covered California to address this and other issues before the next open enrollment period. As part of the audit, DMHC has hired pmpm Consulting to contact practices to survey the accuracy of the networks both plans have posted on their websites. SFMS/CMA strongly encourages the practice to respond to their questions if contacted by pmpm Consulting. This is an investigation into the accuracy of the plan directories and whether the plans have violated any laws, not an investigation of physician practices. DMHC expects to complete its investigation in approximately 60 days. Findings of the survey will be released publicly prior to the next Covered California open enrollment period, which is scheduled for November 15. Patients who are having trouble finding an in-network physician or facility are encouraged to contact the DMHC Help Center at (888) 466-2219 for assistance. We also ask that physicians notify CMA at (888) 401-5911 if they are experiencing difficulties finding in-network providers to whom they can refer patients so that we may raise the issue with the plan, Covered California and the appropriate regulator. Comments are closed.
