Anthem Blue Cross Amending Some Physician Contracts to Include Individual/Exchange Product
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 California Medical Association (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 the letter also states 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.
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.)
Though not mentioned in the Blue Cross cover letter, Sections VI and VIII of
the enclosed amendment provide instructions for physicians who wish to opt out
of the individual/exchange network. Physicians who do not wish to
participate in this network must notify 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.
CMA is working with Blue Cross to obtain additional clarification on the
amendment and will provide updates as they are received.
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.
As always, physicians are encouraged to carefully review all proposed
amendments to payor contracts. You do not have to accept substandard contracts
that are not beneficial to your practice.
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.
Contact: CMA reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.