April 17, 2017
Area(s) of Interest: Commercial Payors Payor Contracting Payor Issues and Reimbursement
Anthem Blue Cross recently notified contracting physicians of a change to its Medi-Cal managed care product in 10 Northern California counties. According to the notice, as of February 1, 2017, Anthem has contracted with River City Medical Group (RCMG) for its Medi-Cal managed care business in Butte, Colusa, Glenn, Nevada, Placer, Sacramento, Sierra, Sutter and Tehama counties. Previously, Anthem had contracted directly with physicians for services to its Medi-Cal managed care enrollees in many of these counties. The notice states that Northern California Physicians Medical Group will continue to provide services in Butte, Colusa, El Dorado, Glenn, Nevada, Placer, Sacramento, Sierra, Sutter and Yuba counties.
RCMG has advised the California Medical Association (CMA) that any prior authorizations obtained from Anthem directly will be honored by Anthem for 60 days.
CMA already encourages physician practices to check eligibility each time a patient is seen, and this change underscores the importance of double-checking eligibility for these Anthem Medi-Cal managed care patients in affected counties. Physicians who are not contracted with RCMG, but provide services to RCMG patients, are at risk of not being reimbursed for services provided.
If a patient’s treating physician is not participating in the RCMG network, the patient may be eligible to continue to see the out-of-network physician by requesting continuity of care through Anthem. For more information on the conditions that qualify for continuity of care, see CMA’s On-Call document #7051, “Contract Termination By Physicians and Continuity of Care Provisions,” available free to members in the CMA Resource Library. Patients should call the number on the back of their Anthem ID card to request continuity of care.
Physicians who are not contracted with RCMG, but who wish to explore a contract, can contact RCMG Network Development at (916) 228-4300 (option #4).
Practices with questions can contact RCMG directly at (800) 928-1201.