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July 2018: Coordinated Commercial Reimbursement Policy: Rollout Begins July 1, 2018

Care providers and payers both play important roles working together to build a more sustainable health system. By collaborating on efforts grounded in the Triple Aim of improving the patient experience and supporting better health while lowering overall costs, we can support the industry’s move away from volume-based activity and toward incentivizing a focus on value. This move requires simpler administrative processes and lower costs coupled with payments that emphasize quality and better outcomes. Updating and simplifying our current reimbursement policies is just one of the ways we’re supporting this movement

What does this mean to care providers?

  • Combining Policy Changes into One Release: Through your feedback, we heard you wanted policy changes combined together rather than introduced piece by piece, while also identifying opportunities to use more consistent reimbursement policies across all products (commercial, Medicare, Medicaid). This is an important step to create a more consistent, predictable experience, and that’s why we are announcing several policy changes together that become effective during the second half of this year.
  • Increased Reimbursement for After Hours and Weekend Care: We’re increasing reimbursement to primary care providers (PCPs) for after hours and weekend care, recognizing the additional resources needed to serve our members, while enabling delivery of consistent care by their established PCP and resulting in lower member cost share. Many members incur higher out of pocket costs when accessing healthcare in the ER and/or Urgent Care settings. This is part of our ongoing efforts to redirect more payments to PCPs and strengthen the primary care model.
  • Additional policy changes including, Vision Screening CCI Editing, Durable Medical Equipment, Orthotics and Prosthetics Multiple Frequency, New Patient Visit and Non-Patient Facility Laboratory Services policy updates are outlined in the chart in the Network Bulletin.