Earlier this year, Blue Shield began recontracting with physicians across the state. Doctors in Humboldt, Kern, Madera, Sacramento, San Diego, Sonoma and Ventura will be next to see the new contracts.
The reason for the recontracting initiative, according to Blue Shield, is twofold: 1) Blue Shield has not done a large scale recontracting with physicians in over a decade, so the new contracts will allow Blue Shield to ensure consistency and compliance with new laws and regulations; and 2) Blue Shield will be offering various tiered networks based on price point in anticipation of California’s health insurance exchange, a key feature of the federal health reform law. Physicians are under no obligation to participate in any of these products. There is no fee schedule change associated with the recontracting initiative, with the exception of the Direct Contract HMO Medicare Advantage product.
While the new contract will eventually be rolled out statewide, the first few phases have focused on the following counties:
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Blue Shield Notice Date |
Counties Affected |
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Fresno |
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Alameda, Alpine, Amador, Calaveras, Colusa, Contra Costa, El Dorado, Lake, Lassen, Marin, Mariposa, Mono, Monterey, Napa, Placer, Plumas, Riverside, San Benito, San Bernardino, San Francisco, San Joaquin, San Mateo Santa Barbara, Santa Clara, Santa Cruz, Solano, Sutter, Tehama, Tulare, Yuba |
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Los Angeles |
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Humboldt, Kern, Madera, Sacramento, San Diego, Sonoma, Ventura |
The cover letter that accompanies the new contract requests that physicians review, sign and return the new agreement by a particular date. However, Blue Shield has assured CMA that failure to sign and return the new agreement will not affect a physician’s participation status with Blue Shield.
To assist physicians, CMA has completed an analysis of the new Blue Shield contract, which is available to members in CMA's online resource library. Physicians are encouraged to carefully review and understand the vast range of legal and practical implications associated with the execution of any new contract. For additional information on evaluating and negotiating complex managed care contracts, see CMA’s contracting toolkit, "Taking Charge: A step by step guide to evaluate and prepare for negotiations with managed care payors." The toolkit is also available free to members in CMA's resource library.
Physicians with concerns about the new contract terms are encouraged to contact Blue Shield Provider Services at (800) 258-3091.
Contact: Reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org.