Three major exchange plans provide guidance for physicians March 20, 2014 Managed Care Blue Shield, Covered California, Health Insurance Exchange, Health Net, Anthem Blue Cross 0 Three major managed care payors offering coverage through Covered California have provided additional information to their contracted providers on their exchange/mirror products. Together, these three payors – Health Net, Anthem Blue Cross and Blue Shield of California – account for approximately 75 percent of enrollment in Covered California products to date. The notices, sent to physicians within the past few weeks, were cobranded with Covered California and contain additional information to help providers navigate the exchange. The Health Net notice, sent on March 7, includes information such as the exchange/mirror products in which the physician is listed as participating, the product types that are offered in different regions and what information is on patient ID cards. Blue Shield sent two notices, one for its EPO and one for its PPO. The notices, sent on March 14, were very comprehensive, containing clarification on “mirror” products, a plan summary that includes copayment, coinsurance and deductible information, sample ID cards, answers to frequently asked questions, a map indicating which product types are offered by county and additional useful tools. Anthem Blue Cross's notice, sent on March 17, includes answers to frequently asked question, clarifies that it is offering a narrowed network for its exchange/mirror product enrollees, a breakdown of products sold by county, reported provider network size and a helpful plan name guide to assist practices in identifying their exchange/mirror product patients. While the notices were only sent to contracting physicians, the information may also be helpful to non-contracting physicians. To help practices navigate the exchange, CMA has also published several “Surviving Covered California,” tip sheets, which are available free to members in CMA's exchange resource center at www.cmanet.org/exchange. There you will also find many other exchange resources, including a comprehensive exchange toolkit, "CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange.” Contact: CMA’s reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. Comments are closed.
