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Provider Stability Act coming soon!

Learn how it affects you.

Provider Stability Act coming soon!

Learn how that affects you.

Provider Stability Act

What It Means to You

On Jan. 1, 2019, the Provider Stability Act (PSA) will take effect. This is good news for providers across Tennessee, because it will require health plans to provide more transparency when making changes to policies, procedures and fee schedules. The law only applies to Commercial providers at this time.

As an overview, the law will require all Tennessee health plans to give you more time to react to changes we make at our discretion. In addition, it will limit the number of times we can make certain types of changes. Learn more about the law and how it will affect you.

We Need Your Email Address for Important Updates

By law, we’ll need to try to send you PSA-related notifications by email. From the Contract Details screen, you’ll need to confirm your contracting email address and Opt In for these communications.

Click here for directions on how you can verify your contact preferences through Availity.

If you haven’t registered with Availity, please do so today. This will be your main resource for all PSA-related notifications.

We Need Your Updated Mailing Address, Too

If we can't reach you by email, we'll need to send communications by mail. If your mailing address isn't correct, please:

  1. Download and follow the instructions on our Provider Change Form.
  2. Go to CAQH ProView® to make sure your information matches what you submit to BlueCross.

Thank You for Your Help with This Important Initiative

We appreciate your partnership in caring for our members – and we want to make sure you get the information you need to be successful. By providing your updated email address, you’ll get what you need faster and receive fewer mailings at your busy office.

If you have questions about:


Availity, contact Availity at 1-800-AVAILITY (282-4548) or our eBusiness technical support team at (423) 535-5717, option 2 or ebusiness_support@bcbst.com.


This email collection request, contact your local Provider Network Manager.


The PSA or network participation, call Provider Network Services at 1-800-924-7141 and follow the prompts for Networks and Contracting or send an email to contracts_reqs_gm@bcbst.com. You can also contact your Provider Network Manager for help.


Details About the Provider Stability Act

For your convenience, you can refer to the actual law, which was signed into effect April 5, 2017. Or, you may review the highlights below:

Changes to Provider Manuals, Reimbursement Rules or Policies

When an insurer makes changes to a provider manual, reimbursement rule or policy, the insurer must disclose or identify that information at least 60 days before the change takes effect. Here’s how we’ll communicate these changes to you:

  • We’ll use bold print or a larger font to identify changes in our Provider Manuals.
  • We’ll send you a separate communication about reimbursement rule and policy changes and their effective dates.

Changes to Fee Schedules

Insurers must give you at least 90 days’ notice about any fee schedule changes and effective dates. We cannot make fee schedule changes more than once in a 12-month period. However, a health insurance carrier and a hospital may agree to changes in writing. Here’s how we’ll communicate these changes:

  • We’ll send the required notice and identification to your dedicated email address or as otherwise mentioned in your BlueCross contract.

 

Exceptions include changes to your:

  • Fee schedule effected by the state or federal government
  • Reimbursement for drugs, immunizations, injectables, supplies or devices if you and the health insurance carrier or PBM agreed reimbursement will be based on an index not established by the health insurance carrier
  • Reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and the carrier or PBM have previously agreed to reimbursement based on maximum allowable cost pricing
  • CPT®, HCPCS, ICD or other code sets recognized or used by CMS that a health insurance carrier used in creating your fee schedule
  • Revenue codes as established by the National Uniform Billing Committee (NUBC)
  • Fee schedule due to one or more of the following if previously agreed to in a provider’s agreement with a health insurance carrier:
    • Payments made to you are based on values or quality measures explicitly described in your agreement and intended to improve the quality of care provided to our members
    • Escalator or de-escalator clauses
    • Provisions that require adjustments to payment due to population health management performance or results
    • Tennessee Healthcare Innovation Initiative (THCII)

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