MINNEAPOLIS. May 1, 2008—The MMA, West Metro Medical Society (WMMS), East Metro Medical Society (EMMS), and the Minnesota Medical Group Management Association (MMGMA) have teamed up to provide their members a review of the changes made in the 2008 BCBS Aware Provider Service Agreement.

While the number of changes to the contract this year are limited, some are significant and merit attention, including:

1. a new provision that restricts BCBS payment, and providers’ ability to bill for additional medical expenses resulting from providers’ “negligence, omission or error” (these terms, however, are undefined);
2. a change in how payment limits are determined based on the lesser of the BCBS fee schedule or 90 percent of billed charges (previously was at 100% of billed charges); and
3. a new twice-a-year limit on providers’ ability to access fee schedules from BCBS.

The MMA, WMMS, EMMS, and MMGMA are working to seek clarification from BCBS on the medical errors provision of this contract, particularly since the provision appears to be an expansion (to professional services/ambulatory care) of other error-related payment policies adopted by other payers, including CMS.

If you are interested in determining the specific application of this Agreement to your practice, or in negotiating alternative terms of the agreement, you will need to contact your attorney, accountant or consultant.

Complete list of BCBS Contract Reviews