Responding to complaints from hundreds of CMA physicians, the Department of Managed Health Care (DMHC) has forced Blue Cross to delay implementation of its new fee schedule and take appropriate measures to notify doctors of the rate changes. The new implementation date is August 6.

According to DMHC, Blue Cross has agreed to make new the fee schedule available for download by Friday. The PDF download will include the proposed fees for all CPT codes. (Go to the Blue Cross provider website, log in, and click on "Request Pricing " under "What's New." If you don't already have a username/password, click here to register.)

As you’ve read in previous issues, Blue Cross failed to provide physicians with timely access to the new fee schedule, leaving many physicians unable to assess the financial impact that the fee schedule changes will have on their practices. The new fees were scheduled to take effect June 1.

CMA first brought the problem to DMHC’s attention in early May, after learning that the fee schedule was not made available by April 15, as required by law. California’s unfair payment practices law (created by a CMA-sponsored bill) requires insurers to fully disclose to contracting physicians their fee schedules and payment rules and to notify physicians in writing 45 days before instituting any changes to fee schedules and payment rules.

DMHC did nothing to stop the June 1 implementation, and took no action until hundreds of CMA physicians phoned and e-mailed the department to express their outrage. “Clearly, hearing the anger and frustration from the physician community made a difference,” says CMA President Anmol S. Mahal, M.D. “Our actions caused the DMHC to change course. We let regulators know we are a force to be reckoned with.”

When CMA recently surveyed members about this issue, a number of physicians not only reported to CMA that were they unable to access the new fee schedule, but also that they were not even notified by Blue Cross about the impending contract changes. DMHC has indicated to CMA that it will continue to investigate this failure.

CMA also believes Blue Cross is in violation of the RICO settlement, in which it agreed to provide greater notice of policy and procedure changes. CMA has filed a dispute with the RICO lawsuit compliance dispute facilitator.

Contact: CMA’s reimbursement help line, 888/401-5911 or jblack@cmanet.org.