Blue Cross Blue Shield of Kansas (BCBSKS) recently mailed their Competitive Allowance Program (CAP) contract changes for 2018 to all CAP providers. The document provides notice of changes to reimbursement or Maximum Allowance Payment (MAP) and policies for the upcoming year. KMS encourages its members to carefully review this and all contracts. According to the document, BCBSKS serves 987,957 Kansans across all lines of business as of May 2017. Administrative expense is down at 9.6 percent.

The most positive component of the contract is the opportunity to receive incentive payments through the Quality Based Reimbursement Program (QBRP). BCBSKS is projecting $78 million in QBRP incentives for both physicians and hospitals in 2017. Providers, depending on specialty can earn as much as 20.5 percent when all components of the program are met. The QBRP metrics are multiplied individually by the MAP then totaled with the MAP to determine the total reimbursement – not to exceed billed charges.

A charge comparison report reflecting reimbursement change for 2018 is available by contacting your professional relations representative or the professional relations hotline at: 800.432.3587. The charge comparison is based on services billed by you during the first five months of 2017. The report also reflects which procedure code(s) qualifies for QBRP.

If you wish to terminate your provider contract, you must send a signed correspondence postmarked no later than midnight, September 3, 2017 to Doug Scott, Director of Professional Relations, cc480D2, 1133 SW Topeka Blvd., Topeka, KS 66629.

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KaMMCO 2018

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