January 29, 2016
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management
In December 2015, the California Medical Association (CMA) began receiving calls from physicians who had received requests from Blue Shield of California to complete its Provider Data Confirmation form. According to Blue Shield, the requests are an effort to comply with Senate Bill 137, a new law that requires payors to maintain accurate provider directories (among other things). Blue Shield is asking that participating providers review and complete the form to indicate whether the data it has on file for each provider is accurate, incorrect or incomplete.
Some physicians, however, had expressed concern with one of the questions on the form, which asked if the doctor was “accepting NEW patients for ALL member plans.” The form then stated that choosing “no” would suppress the physician from all PPO member networks.
Physicians expressed concern with how to accurately respond to this question if they are accepting new patients, but only for the products for which they are contracted with Blue Shield. For example, if a physician was contracted for the commercial PPO product, but not for Blue Shield’s exchange product, would answering “yes” somehow obligate that physician to see exchange patients in the future? Alternatively, there was concern that if the physician answered no in this situation, that Blue Shield would remove that name from its provider directory.
CMA raised these concerns with Blue Shield and learned that that based on provider feedback, it had revised the form. Effective January 1, 2016, the question now asks whether providers are accepting new patients in all plans for which they contract. The form also now indicates that if providers choose “no,” Blue Shield will simply update its provider directory to indicate they are only accepting current patients, as opposed to removing their names from the provider directory.
Questions about the Provider Data Confirmation form can be directed to Blue Shield Provider Information and Enrollment at (800) 258-3091.