Audience: All providers
We would like to provide an update and reminder regarding requirements under the Consolidated Appropriations Act (“CAA”), which was signed into federal law on December 27, 2020.
Requirements include key changes to Excellus BlueCross BlueShield’s tools for members and other consumers, which were provided in our bulletin issued August 12, 2021.
Provider Directory Information Requirements
To be compliant with provider directory requirements of the CAA, the terms of your participation agreement with Excellus BlueCross BlueShield (“Agreement”) are hereby amended. Effective immediately, you are required to submit the provider directory information listed below when: a) you enter into a participating provider arrangement with us; b) at least thirty (30) days prior to termination of your participation agreement with us; c) when there are material changes to the information listed below previously provided to us; and d) at any other time (including upon our request) determined appropriate by you or any state or federal regulatory agency. The information/updated information to be provided includes:
- Provider name
- Provider tax ID
- Provider NPI
- Provider taxonomy codes
- Payment address
- Directory listing including provider address, phone number, fax number and, for primary care providers who participate in managed care products, languages spoken and whether the practice is accepting new patients (open or closed)
- Service addresses
- Changes in coverage arrangements
- When one or more practitioners join the group practice
- When one or more practitioners leave the group practice
- Provider specialty
- Provider digital contact information
Our Participating Provider Manual is being updated to reflect this requirement.
Continuity of Care
We remind you that in accordance with applicable state and/or federal law, Excellus BCBS may approve a member to continue an ongoing course of treatment with a provider for a period of up to 90 days after the provider’s contractual obligation to provide services to the member terminates, or if the member is pregnant at the time of the provider’s disaffiliation, through delivery, including delivery-related post-partum care.
A provider whose termination is related to fraud, quality of care or disciplinary action is not eligible to provide transitional care.
Please note that if you are an eligible provider who provides transitional care to an eligible Excellus BCBS member, you are required to accept reimbursement for those transitional care services at the rates of reimbursement that were applicable prior to the start of the transitional period under the terminated participation agreement with the Health Plan, as payment in full, except for the member’s in-network cost-sharing.
Also, such provider would be required to comply with all Excellus BCBS policies, procedures, and quality standards in the same manner as if the provider’s termination had not occurred.
We hope that you find this information helpful. We will continue to share information about the federal mandate enforcement as it becomes available, as well as Health Plan solutions that may impact your practice or patient experience.
If you have questions, please contact your Provider Relations representative.Email this article