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Blue Shield fee schedule changes took effect November 1



November 09, 2015
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement 

In August, Blue Shield announced changes to its physician fee schedule that became effective November 1, 2015. In a notice sent to physicians, the insurer said that it was increasing payments for the more commonly billed office visit codes. 


The new rates are available on the Blue Shield website (go to www.blueshieldca.com/provider and log in, then select the “Professional Fee Schedule” link located under the "Claims" section menu). Physicians can also request a copy of the new fees by completing the allowance review form enclosed with the notice, or by calling the Blue Shield Provider Services Department at (800) 258-3091.


To help physicians understand their rights when a health plan has sent notice of a material change to a contract, the California Medical Association (CMA) has published “Contract Amendments: an Action Guide for Physicians,” available in CMA's online resource library. The guide includes a discussion of options available to physicians when presented with a material change to a contract. Additionally, the guide includes a financial impact worksheet that will help physicians calculate the net impact of the fee schedule changes on their practices.


Click here to view a copy of the notice that was recently sent to physicians.

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