Discover more from ROC - Rehab Owners Community
Teaser - October 10th I Monthly Mastermind Call
Anthem & BCBS Industry Changes - September 2023
Anthem BC of CA Network Changes for Vivity and Priority Select Plans
Anthem Blue Cross of California has made significant network changes that may impact your patient's healthcare coverage.
In January 2023, Anthem of CA initiated changes to their network, excluding Pathways plans from most network contracts.
As of September 15, 2023, Anthem of CA has narrowed its network yet again by adding the exclusion of Priority Select HMOs and Vivity HMOs.
This change affects specific plans, which can be identified by their associated "contract codes." You can access the contract code mappings for each plan on Availity.
It is important to note that only some plans with these prefixes have been impacted. The impact depends on each plan's specific network and contract code. For instance, while NCF is the most common prefix on this list, not all NCF plans are affected. Therefore, evaluating the impact on a case-by-case basis will be necessary.
The prefixes that seem to be impacted by these network changes include, but may not be limited to:
NCF – Though NCF is the most common prefix on this list, keep in mind that not all NCF plans are affected.
Join us on Tuesday, October 10th at 2:00 PM EST for a detailed discussion on how this will affect you and to explore additional action items.
Updates on Blue Cross Blue Shield Policies Found on the Marketplace for Specific States
Recently, we have seen a significant increase in requests for medical records associated with Marketplace policies falling under the Health Care Service Corporation (HCSC) umbrella.
This trend explicitly affects BCBS plans purchased on the exchange originating from the following states: Illinois, Texas, Montana, Oklahoma, and New Mexico.
This surge in requests for medical records has had a notable impact on the timelines of claims processing, adversely affecting facilities that provide care to patients from these states when they seek treatment out-of-state.
Below are a few examples of how this is affecting certain states.
Example 1: Patients covered by an Illinois Marketplace plan receiving care in the state of Tennessee.
Example 2: Patients covered by an Oklahoma Marketplace plan receiving services in the state of California.
Aetna Eliminating Virtual Coverage
Despite telehealth being a proven, equally effective means of treatment to its in-person counterpart, Aetna leads the pack in removing virtual treatment for IOP and PHP.
Who does this impact?
One out of every 5 people in the United States had a mental illness in 2019 — a total of 51.5 million people. Then COVID-19 struck.
About 150 million people in the U.S. live in a federally designated mental health professional shortage area. The gap in specialized care, such as IOPs and PHPs, can often be more significant. reference
Many patients will go untreated altogether, which will likely increase costs in other areas of the healthcare and social services systems…” Justin Brown. reference
What does this mean?
It may be “as simple” as licensure - ensuring the doctor is licensed to practice in as many states as possible; however, state medical boards often try to block out-of-state physicians from seeing patients in their jurisdictions. reference
Now that we’re reverting back to pre-pandemic rules, we must use this final quarter of the year to prepare for impact.
What should you do?
Review your numbers - one payor reported 15% of their IOP & PHP visits as virtual, while AAMC reported that 40% of mental health services were provided via telemedicine last year.
Masterminds Discussion: Join Us on Tuesday, October 10th
On Tuesday, October 10th at 11:00 AM PST, we will explore the following topics.
In the meantime, we advise that you ensure your admission team is well-informed about these developments. They will be instrumental in streamlining processes and mitigating potential delays or complications when screening patients.
Industry Trends Entering Q4: Gain insights into how these changes will impact your operations.
Payor Changes: Learn how these policy changes may impact your financial and operational strategies.
Gating Policies: Learn about policies that restrict patients from seeking treatment outside their state of residence. Discover how these policies may affect your patient care practices.
Denials: Dive into the reasons behind claim denials and learn effective strategies for minimizing denials and optimizing revenue.
Join us to stay informed, empowered, and ready to face the challenges of the healthcare industry in September 2023 and beyond.