January 09, 2011
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
Blue Cross has, for an eighth time, announced an extension to its Healthy Families continuity of care plan in most counties.
However, the California Medical Association (CMA) has learned that the Department of Managed Health Care (DMHC) is expected to approve the networks in the remaining Blue Cross Healthy Families counties sometime in January. With that approval, Blue Cross would no longer be required to offer a continuity of care plan, meaning doctors would have to be in Blue Cross' Health Families network in order to get paid.
As you may recall, Blue Cross announced in March last year that it would require physicians to sign a separate contract and accept reduced rates if they wanted to continue treating Blue Cross-insured patients through the Healthy Families and Access for Infants and Mothers programs. The new lower payments vary but hover just above Medi-Cal rates.
Although the effective date on the new contracts was Sept. 1, 2009, the insurer has extended its continuity of care plan through Jan. 31 for patients in all counties except San Bernardino, Riverside and Orange. The continuity of care plan for those three counties expired Aug. 30, 2010.
CMA is currently working with DMHC and Blue Cross to understand how and when the continuity of care plan transition will occur. CMA will provide additional information as it becomes available.
The continuity of care plan provides that in lieu of a newly signed Healthy Families contract, physicians with Prudent Buyer contracts will be paid 125 percent of Medi-Cal for most Healthy Families services.
Contact: Reimbursement Helpline, 888/401-5911 or email Economic Services.