As part of a more than $200 million commitment to support healthcare providers and hospitals facing financial pressures as a result of the coronavirus (COVID-19) pandemic, Blue Shield of California has announced additional details on four programs available to qualifying network providers.
The nonprofit health plan has received strong interest in the program since the April 6 announcement. Hospitals, medical groups, IPAs and independent physicians (primary care providers and specialists) that are currently part of Blue Shield of California’s provider network are eligible to apply for these programs.
The program options include:
Blue Shield has begun directly providing funding to eligible providers as a pre-payment for future services. No repayments are required during a six-month grace period, after which repayment amounts will be offset from claims payments, generally in equal installments over twelve months. For HMO providers, repayment amounts will be offset from monthly capitation payments.
Blue Shield intends to guarantee loans issued by a third-party lender to providers. The loans, not to exceed $2 million (other limits apply) will be available with flexible repayment terms. Further details about this initiative will be announced soon.
Assuming member liability obligations through OODA Health
OODA Health is working with Blue Shield to expand its service offering that pays Blue Shield members’ liability to providers more quickly. There will be two components: First, qualifying providers can arrange for OODA to assume responsibility for member out-of-pocket costs on future encounters. Second, providers can transfer certain existing Blue Shield member’s share receivables to OODA for collection. Receivables will be transferred at a negotiated rate upfront, with the potential for additional payments based on actual collection rate and subject to final terms of agreement.
Transitioning to value-based agreements
Blue Shield will work with select Commercial providers to convert their existing fee-for-service agreements to a value-based contract (where available) or a risk-sharing capitated contract that provides a monthly base revenue stream. Providers may be eligible to receive prepayments on the monthly revenue and participate in technology-enabled tools and services designed to help make medical practices more efficient and effective.
For more information and to receive an application for the programs, providers are asked to send an email to Financecommunication@blueshieldca.com.
“We want to do all we can to help our providers during the COVID-19 pandemic. By providing a range of options for financial support we hope to ensure providers and members have the support they need during this difficult time,” said Sandra Clarke, CFO and senior vice president, Blue Shield of California.
The financial support programs are part of Blue Shield of California’s range of initiatives offered to help patients, their providers and the community.
Additional steps to help remove administrative burden for providers include:
- Extending new and existing prior authorizations for elective procedures from the usual 120 days to 180 days.
- Streamlining initial clinical concurrent reviews to reduce provider documentation requirements.
- Waiving prior authorization requirements for transfers of post-acute patients when a member is moved to a different site of care, including skilled nursing facilities and extended acute rehabilitation facilities.
Blue Shield also has taken the following steps to further support healthcare providers and patients:
- Waiving members’ coinsurance, copayments and deductibles for COVID-19 screenings and testing.
- Waiving members’ coinsurance, copayments and deductibles for COVID-19 medical treatments through May 31, 2020.
- Eliminating member cost sharing for our Teladoc telehealth services through May 31, 2020.
Click here to read more about how we are responding to the coronavirus outbreak to ensure we can continue to deliver on our nonprofit mission.