October 2023: ROC Monthly Masterminds Call
October 2023: ROC Monthly Masterminds Call
Aetna, Anthem, & BCBS Payor Changes – October 2023
Aetna, Anthem, & BCBS Payor Changes – October 2023
Reminder: Our November Masterminds call will be canceled, but we will see you on Tuesday, December 12th! More info to come.
There have been several significant network changes with certain insurance companies
which affect various aspects of patient care and insurance coverage.
Thank you to our very own Erin Burke, CEO and founder of Hansei Solutions, for talking us through these changes and guiding us on how to navigate them.
View Recording:
Passcode: 2YK0pQ1&
Change #1: Anthem BC of CA Network Changes
Anthem Blue Cross of California made significant network changes in January 2023, one of which was to exclude Pathways plans from most network contracts. On September 15, 2023, they further narrowed their network by excluding Priority Select HMOs and Vivity HMOs. The impact varies depending on specific plan contract codes. Not all plans with the affected prefixes (such as NCF) are excluded.
Important note from the Masterminds discussion: The prefixes that seem to be impacted by these network changes include, but may not be limited to:
WEP
DVN
CAI
NCF
V7Y
Further details can be found on Availity.
Change #2: Updates on Blue Cross Blue Shield Policies
There has been a surge in requests for medical records related to Marketplace policies under the Health Care Service Corporation (HCSC) in states like Illinois, Texas, Montana, Oklahoma, and New Mexico. This has caused delays in claims processing, particularly for patients receiving out-of-state care.
Important note from the Masterminds discussion: Even if your state is not currently listed, it doesn't imply immunity from potential impacts. Ensure medical records are timely and thorough, keep an eye on any new patterns that may emerge, and plan for claim processing delays.
Change #3: Aetna Eliminating Virtual Coverage
Aetna is discontinuing virtual treatment for Intensive Outpatient Programs (IOP) and Partial Hospitalization Programs (PHP), despite the effectiveness of telehealth. This change affects a significant portion of the population, challenging licensure and state restrictions.
Important note from the Masterminds discussion: Though there is no concrete evidence for future changes, it’s assumed that other major payors will follow Anthem in the elimination of virtual coverage for IOP and PHP.
More information can be found here.
We encourage you to stay informed about industry trends, learn about gating policies that restrict patients from seeking treatment outside their state of residence, and prepare your facility(s) for 2024.