PDA Contracting Flash

PDA Contracting Flash 20160126


PDA Contracting Bulletin

As Friday moves past…

☑︎ Blue Cross Blue Shield “Blue Choice PPO” signed off by the Chairman and contracting team prior to being sent to the carrier.

☑︎ “Blue HMO” currently in place and supported by IPA members. A follow-up review has occurred.

☑︎ Blue Cross Blue Shield “Medicare Advantage PPO” reviewed with providers who have already accepted the plan.

☑︎ Blue Cross Blue Shield “Medicare Advantage HMO” signed and off to the Carrier.

☑︎ Blue Cross Blue Shield “Blue Advantage HMO”, i.e., an individual product. Signed off and sent to Carrier.

☑︎ Blue Cross Blue Shield “Blue Advantage HMO Plus”, a variation of Blue Advantage HMO but still requires a PCP, and choice of a bronze, silver, or gold format. Signed off and sent to Carrier.

☑︎ “Blue Premier” has no out-of-network option and Carrier has right to invite providers either into the network or not. Plan has a narrow network, HMO type fee schedule. Signed and sent to Carrier.

☑︎ “Blue Essentials” has a fee schedule like “Blue HMO” and allows some out-of-network. Reviewed and sent to Carrier.

☑︎ Scott & White Health Plan provider network contract has been reviewed and is ready for “Opt-In.”

This has occurred over 15 ± days since the first of January 2016. The insurance industry is moving fast, both to stay in business and to limit some of the financial issues and inequities associated with the Affordable Care Act. This is combined with the CMS push for “pay-for-performance”.

The interests and advocacy of independent providers is the main mission of PDA. This work is all about demonstrably committed service.

More to come!


2016 and beyond…

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