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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
- 4th Quarter 2009 [PDF]
Featured topics: Healthcare reform, Credentialing requirements for diagnostic imaging centers, AdvantageBlue network expiring, Filing POA indicators, Reimbursement for multiple births, Updated H1N1 vaccine billing information, Member cost sharing, Limited benefit products, Changes in licensees, Walmart associates have new home plan, Medical policy updates, Formulary updates, Free wellness plan for Blue Cross customers, 2010 Product enhancements 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
- January 2010 [PDF]
Featured topics: Healthcare Reform, Enhanced Online Access to Hospital Patient Experience Information, Blue Surgical Safety, Serious Preventable Events Policy, POA Indicator Required on Facility Claims, Two Top Publications Take Aim at Rising Health Costs, Hospital Governance and the Quality of Care, S & P Reaffirms BCBSLA’s “A” Rating, Minden Medical Center Receives Hospital Value Index™ Quality 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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