Blog
Claims Payment Change for Out-of-Network Emergency Services
Susan Heard outlines what you need to know
BlueCross BlueShield of Tennessee (BCBST) has announced that it will change the way it pays claims for out-of-network emergency room visits and care by out-of-network hospital-based physicians (HBP), for example, anesthesiologists, pathologists, radiologists and others.
Joel joined Paradigm Group in 2013 with more than eight years of experience in the financial industry. Grubbs works with clients' employees to help improve their financial understanding.
Reminder: January 1 Health Plans Must Submit On-Line Creditable Coverage Disclosure Forms to CMS by March 1, 2013
Group health plan sponsors that provide prescription drug coverage must disclose to CMS on an annual basis no later than 60 days after the beginning of the plan year. For January 1 plan years, the deadline is March 1, 2013.
Since early 2010, the Affordable Care Act (ACA) has been in the news and on the minds of all Americans. With the elections concluded and court challenges resolved, new guidance and regulations are emerging almost daily. Now is a critical time for preparation and decision making for 2014 compliance.
Bob Dugan joined Paradigm Group in 2013. He has more than 25 years of experience in employee benefits consulting and has worked to the entire spectrum of benefit plans to many diverse clients nationwide.
PCOR Fee Regulations Issued
Learn More Here
We’ve mentioned the PCOR fee as part of earlier health care reform reporting, but regulations that provide details about how the fee will be implemented were recently published.
The Patient-Centered Outcomes Research Institute (PCORI) was created by the Affordable Health Act (ACA) to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.
In November, your members should have received a postbard from BCBST letting them know that they will be getting new ID cards soon that reflect the change in pharmacy benefit managers from Caremark to Express Scripts starting January 1, 2013. Express Scripts purchased Medo earlier this year. Members should destroy their old ID cards and being using the new ones on January 1. While BCBST has made arranges for existing prescriptions with refills to migrate to the Express Scripts system, there are a number of pharmacies that will no longer participate in the mail order program.
Susan Heard, vice president of Nashville-based Paradigm Group, will answer employee benefits, human resources, and health care reform questions from local business owners during the Nashville Area Chamber of Commerce’s “Ask the Expert” forum. Heard has been named a leading expert by the Chamber based on her extensive experience in the human resources field.
Obama Wins Re-election: Health Care Reform Moves Forward
Read Your Next Steps Here
Employers may consider their roles as providers of employee health care coverage ¾ and whether to continue providing coverage. The “pay or play” penalties provide some incentive for employers to offer coverage (since they will be at risk for significant penalties if they do not); however, employers may decide that paying penalties is more cost-effective than paying the ever-increasing costs of coverage for employees and their families.
New BCBST Guidelines for Network Ancillary Providers Raise Concerns
Read Susan Heard's Assessment
In September, BlueCross BlueShield of Tennessee (BCBST) notified members of new claims procedures for certain ancillary benefits, citing a requirement by the BlueCross BlueShield Association. The new claims procedures were to have been effective October 14 but BCBST has postponed implementation for the rest of 2012. In September, BlueCross BlueShield of Tennessee (BCBST) notified members of new claims procedures for certain ancillary benefits, citing a requirement by the BlueCross BlueShield Association. The new claims procedures were to have been effective October 14 but BCBST has postponed implementation for the rest of 2012.