West Coast Blues contracts?

[Anonymous]

Are we getting any West Coast Blues contracts? They're shutting down most of the Blue Card billing now, so we're gonna be out-of-network pretty soon...

 

[Anonymous]

What do you mean? Are they working on any contracts in California?

 

[Anonymous]

What do you mean? Are they working on any contracts in California?

Gonna need to - starting in Oct 2012, all Blues plans are being required by the BCBSA to reject any lab claim involving specimens that were drawn outside of that plan's service area. For example, if Bostwick's Virginia lab bills the Virginia blues plan for testing on a specimen drawn in Nevada, that Virginia plan will reject the claim, and insist that Bostwick bill the Nevada blues plan.

If Bostwick doesn't have a contract with that Nevada Blues plan, their NV claims will pay at a substantially reduced out-of-network rate, and the patient will be stuck with a large balance billing.

So - getting Blues contracts is job #1 right now for labs that have relied on billing all their services through 1 or 2 Blues plans. And unfortunately, the Blues plans are shutting the door on adding path or clinical labs that are offering essentially the same services as their currently contracted labs are offering.

A piece of advice - bring these facts up to your management and see what they're doing to deal with the situation. You've got a right to be very concerned if they aren't getting Blues contracts in your sales area.