Health Plans

BCBS announces contract changes for 2014

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Blue Cross Blue Shield of Kansas (BCBSKS) recently mailed their Competitive Allowance Program (CAP) changes for 2014 to contracting providers. The document provides notice of changes to reimbursement or Maximum Allowable Payment (MAP) and policies for the upcoming year. Most practices simply file the contract away giving it little attention; however, we encourage you to carefully review this and all contracts. Among the highlights for the 2014 contract are the following.

Increase:

  • There is an opportunity for some providers to get as much as a 6.75 percent increase if you participate in the tiered quality program and meet all the program requirements. This program offers opportunity for eligible providers to earn increased reimbursement, based on a two-tiered approach. This reimbursement will be in addition to the established Maximum Allowable Payments (MAPs) for 2014
  • To select Evaluation and Management E/M codes and all codes through Quality Based Reimbursement Program (QBRP)
  • Modifier 25 will have a 25 percent reduction in 2014, down from this year's reduction of 50 percent.
  • Under valued CPT codes (eligible for QBRP)

No Change:

  • Specialized imaging and nuclear medicine (CT, CTA, MRI/MRA, PET) eligible for QBRP
  • Sleep medicine eligible for QBRP

Decreasing:

  • Clinical lab codes, CPT codes 80050, 80061, 82670, 83036, 84153, 84403, 87880 (not eligible for QBRP
  • Some overvalued CPT codes (eligible for QBRP)

A charge comparison report reflecting reimbursement changes for 2014 is available by contacting your BCBSKS professional relation representative or the professional relations hotline: 800.432.3587. The charge comparison is based on services billed by you during the first five months of 2013. If you wish to terminate your provider contract, you must send signed correspondence postmarked no later than midnight, September 3, 2013.

 

BCBS gears up for HIE

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BCBS of Kansas is required to credential their provider network in order to participate on the Health Insurance Exchange as a Qualified Health Plan. The credentialing program is based on the URAC Health Plan Credentialing Standards. BCBSKS has been granted provisional health plan accreditation status, meaning they will be eligible to sell their products on the exchange.

The provisional status will be in effect until URAC's onsite review in early 2014, at which point URAC will ensure that BCBSKS is meeting the required standards, policies and procedures.

If you have not already completed your online CAQH application, please do so at your earliest convenience to help facilitate a smooth credentialing process. Additional information about the credentialing process is available here, or you may contact your provider representative at 800.432.3587.

 

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