October 10, 2019
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement Practice Management
The California Medical Association (CMA) has learned that Anthem Blue Cross has terminated its contract with Hill Physicians Medical Group for the Medicare Advantage product effective October 1, 2019. According to Hill Physicians, the termination will affect approximately 8,000 enrollees in Sacramento County and 200 enrollees in San Francisco County. Anthem is reportedly moving these patients to Nivano Medical Group and Imperial Medical Group. The termination only applies to the Medicare Advantage product and does not affect the Anthem-Hill Physicians HMO, Medi-Cal or PPO/ACO products.
Hill has, however, entered into a strategic partnership with Imperial Medical Group as an extension of Imperial’s Sacramento Medicare Advantage network. This means that Sacramento-area patients can retain their current Hill Physician primary care physicians and continue to access the Hill Physician network of specialists. While Anthem has initiated the reassignment of patients to the Imperial/Hill network subset (known as a “pod”), not all Hill physicians were loaded into Anthem’s computer systems, resulting in some patients being assigned to an alternative physician or medical group. Hill Physicians advises that they are continuing to work with Imperial and Anthem to resolve this issue.
Patients that were assigned to a new physician or medical group can call Anthem member services to request a change using the physician’s new Anthem ID number under the Imperial/Hill pod. (Physicians can contact Hill Physicians for their new ID number.) Current Anthem Medicare Advantage enrollees who were assigned to the new Imperial/Hill pod can continue in that network through 2020.
Physicians are encouraged to obtain updated insurance information and verify eligibility at the time of scheduling, if possible. The new ID cards will look the same but will show “Imperial Health Plan Inc-Central Val” as the medical group. Practices wishing to verify if an Anthem Medicare Advantage patient is assigned to the Imperial/Hill POD should check eligibility through the Hill Physicians Medical Group Provider Portal. For questions related to eligibility, providers should contact Hill Physicians Customer Service at (800)445-5747 or Imperial at (800)497-5509 (option 2).
Hill Physicians will honor authorizations issued before October 1, 2019, if the patient is assigned to the Imperial-Hill pod. If the patient is assigned to Nivano or another group, the patient will need to contact Anthem and request to be reassigned to their primary care physician under the Imperial-Hill pod or a new authorization request will need to be submitted to the new medical group.
Hill Physicians Medical Group has created an Anthem Medicare Advantage FAQ to provide more information regarding this transition. Physicians seeking to obtain a copy of the FAQ or that have additional questions regarding the transition can contact Hill Physicians Medical Group at (800) 445-5747. Additional questions regarding the termination can be directed to Anthem Blue Cross at CAcontractsupport@anthem.com.