June 07, 2019
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement
Physicians are reminded that the changes to the Anthem Blue Cross Prudent Buyer Participating Physician Agreement and fee schedule will take effect July 1, 2019.
According to a notice issued to approximately half of its PPO network, Anthem will be increasing payment for the more commonly billed Evaluation and Management (E/M) services. However, some physicians have reported decreases in payment for other services.
Physicians are encouraged to carefully review the changes and impact to their practice. The California Medical Association (CMA) reminds physicians that they do not have to accept contracts that are not beneficial to their practice
The new rates are available on the Availity website by selecting “Payer Spaces” then “Anthem Blue Cross” (select Education and Reference Center> Administrative Support> Prudent Buyer Fee Schedule update).
To help physicians understand their rights when a health plan sends notice of a material change to a contract, CMA has published "Contract Amendments: an Action Guide for Physicians." The guide—available free to CMA members—includes a discussion of options available to physicians when presented with a material change to a contract. Additionally, CMA created a financial impact worksheet to help physicians calculate the net impact of the fee schedule changes on their practice and make informed decisions.
Physicians with questions about the changes can contact Anthem Blue Cross Network Relations staff at CAcontractsupport@Anthem.com.
Contact: CMA Reimbursement Helpline, (888) 401-5911 or firstname.lastname@example.org.