Should You Sign the New Blue Shield Agreement? October 29, 2012 Payment, Physician Resource Blue Shield Provider Agreement, Blue Shield, managed care 0 The California Medical Association (CMA) continues to receive a high volume of calls from physicians and their staff regarding the new Blue Shield contracts. However, more recent reports from physicians indicate that Blue Shield representatives have become more aggressive in their attempts to get physicians to sign the new contracts. Click here to view an in-depth analysis of the new contract (login required). SFMS/CMA has also prepared answers to the most common questions received from physicians about the new contracts: Why is Blue Shield asking me to sign a new agreement? According to Blue Shield, 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 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 and other new delivery models. The new contract includes three new product types (Networks A, B, and C). What types of products are these? Exhibit B in the Blue Shield contract identifies these networks as Commercial PPO/EPO (Blue Shield Networks A, B, and C), respectively reimbursing at staggered percentages of the rates set forth in the Blue Shield Provider Allowances. Blue Shield has advised SFMS/CMA that these three tiered networks are being offered in anticipation of possible participation in the exchange. 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. Can I designate which products I am willing to participate in? Yes. Exhibit A of the new Blue Shield contract allows physicians to designate which products they are willing to participate in by product type. Additionally, a section of Blue Shield’s frequently asked questions (FAQ) encourages physicians to read Exhibit A carefully to ensure you clearly understand your participation choices. What happens if I do not sign and return the agreement by the date requested? Blue Shield has indicated that if a physician chooses not to sign the new agreement, his or her current participation status with Blue Shield will not be affected. Blue Shield has advised SFMS/CMA, however, that physicians who do not sign and return the new agreement will receive follow-up calls and letters from Blue Shield representatives encouraging them to sign the agreement and return to Blue Shield. It’s important that physicians understand if they do not wish to participate in the new tiered networks offered in anticipation of the Exchange or any other product types offered, they are not required to sign and return the new agreements. Their current participation status will not change. Physicians who want to participate in the new tiered networks will need to decide whether they wish to opt out of any product types and affirmatively do so by checking those product type boxes in Exhibit A number 2, then sign and return the agreement to Blue Shield. As indicated in Exhibit A number 2, by checking the box the physicians is stating he/she does NOT agree to participate in that product. A box left blank indicates the physician AGREES to participate in that product. If you are a SFMS member requiring assistance with Blue Shield contracting, please contact our toll-free reimbursement helpline at (888) 401-5911 or email economicservices@cmanet.org. Comments are closed.
