MINNEAPOLIS, May 28, 2009 - The MMA released a summary of changes made to the Blue Cross and Blue Shield of Minnesota  2009 Aware Provider Service Agreement on Thursday.

As a service to members, the MMA provides an annual review of this Blue Cross contract in conjunction with the West Metro Medical Society, East Metro Medical Society, and Minnesota Medical Group Management Association.

Providers must accept the agreement in order to be part of Blue Cross’s network of providers for its various insurance products.

The agreement automatically renews on July 1. However, providers have 30 days from the date they receive the agreement to notify Blue Cross of their intent to terminate it.  However, Blue Cross has said that providers may opt out at any time.

After reviewing the agreement, providers can  request that amendments be made to their particular agreement.

Significant reimbursement changes in this year’s agreement including the following:

1) Blue Cross will now pay providers for services at the lesser of two rates: 90 percent of the provider’s billed charges (the same as last year) or 103 percent of Minnesota’s Medical Assistance (MA) fee schedule( a 2 percent reductionfrom  last year’s agreement, which listed the payment rate as 105 percent of the MA fee schedule).

This change could result in a significant payment reduction for some providers, particularly since the Legislature and governor cut Medical Assistance reimbursement rates for specialists by 5 percent starting in July;

2) Injectable drugs that are billed with an unlisted code (“Unclassified,” “NOC,” or “NOS”) must include a National Drug Code number and a short description of the drug provided to the patient. Codes submitted with this information and an unclassified code will be reimbursed at 82 percent of the average wholesale price as determined by Blue Cross’s pricing source;

3) Reimbursement for unlisted durable medical equipment codes will default to 55 percent of the provider’s billed charge unless the purchase invoice detailing the provider’s cost is submitted with the bill. If the purchase invoice is included, reimbursement will be based on the purchase price, plus 15 percent; and

4) Blue Cross will not provide reimbursement for services that result in serious preventable medical errors listed by the National Quality Forum. Last year, the MMA, East Metro Medical Society, West Metro Medical Society, and Minnesota Medical Group Management Association worked with Blue Cross to clarify the terms “negligence,” “omission,” and  “error” which were not defined, yet they would result in a denial of payment. This year’s agreement includes a clarification made in response to that effort.