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Special Notice
Thomas/Love Class Action Lawsuit
- http://www.bcbsphysiciansettlement.com/
Website information for Class Members about the Settlement with the Blue Cross and Blue Shield Association and certain Blue Cross and Blue Shield Plans and certain current and former subsidiaries and affiliates in the class action lawsuit known as Love, et al. v. Blue Cross and Blue Shield Association, et al.
- External Review of Billing Disputes
Effective November 21, after physicians or physician groups have exhausted our internal dispute resolution processes under the provider contract, they may submit a billing dispute through MES Solutions, an independent company contracted by us to act as an external billing dispute reviewer. This process is only available to physicians and physician groups, and applies only to disputes regarding the application of coding and payment rules and methodologies. The decision of the external reviewer is binding on both the health plan and the physician.
Adverse Determination Denial Rate
|
Number of Adverse Determinations Sent for External Review |
Percentage of Adverse Determinations Upheld |
Percentage of Adverse Determinations Reversed |
|
45 |
80% |
20% | | |
Providers can stay informed of our news via two publications:
Network News
Network News is a quarterly newsletter for our network providers. Every issue contains Medical Policy Updates and information and tips on changes to processes, such as claims filing procedures or reimbursement changes, along with a number of featured articles.
Latest Issue
- 2nd Quarter 2010 [PDF]
Featured topics: OGB HMO Plan Provider Information & Special OGB Speed Guide insert, Preparing for HIPAA 5010 and ICD-10, Updated Anesthesia Billing Guidelines, New G-Codes for Drug Assays, Self-Administered Medications Update, Preventive & Wellness Benefits, Updates in Mental Health Parity, Refer Members to Network Providers, Authorizations for Out-of-State Blue Members, 2010 BlueCard Program Survey, Lowe’s Employee Authorizations for Specialty Drugs, Medical Policy Update, FEP news and more...
More News
Blue News
Blue News is a quarterly newsletter e-mailed to hospital administrators covering topics of special interest to hospitals.
Latest Issue
- April 2010 [PDF]
Featured topics: Blue Cross Awarded OGB Contract for HMO, Serious Preventable Events, Blue Distinction CentersSM, Blue Surgical Checklist, New Personal Health Statement, Prepare Now for ICD-10, Termination for Non-Payment of Premiums, BCBS System Medical Policy Consistency, NPI Reminder, Consumer’s Right to Know Act Forms Needed, Healthy You, Healthy Blue Wins Health & Productivity Management Award.
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Read other Blue News
To search for a specific topic in Network News or Blue News, enter key words on the search page.
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