May 08, 2019
Area(s) of Interest: Commercial Payors Payor Contracting Practice Management
With Anthem Blue Cross recently announcing changes to its Prudent Buyer Participating Physician Agreement and fee schedule effective July 1, 2019, the California Medical Association (CMA) strongly encourages physicians to review their Anthem fee schedules to see what impact the changes will have on their reimbursements.
According to the 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. But, some physicians have reported decreases in payment for other services including those for pathology and radiology.
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).
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts. CMA reminds physicians that they do not have to accept substandard contracts that are not beneficial to their practice.
To help physicians understand their rights when a health plan has sent 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 notice can contact Anthem Blue Cross Network Relations staff at CAcontractsupport@Anthem.com.
Contact: Reimbursement Helpline, (888) 401-5911 or via email.