Effective July 1, 2014, positive changes will be made to
the IBC and its affiliates (?IBC?) standard fee schedule
for certain professional providers.
The following reimbursement changes under your current Professional Provider
Agreement with IBC will be
effective July 1, 2014, for services provided to HMO, POS, and PPO members
enrolled in commercial and
Medicare Advantage Benefit Programs:
- Monthly PCP capitation. For commercial HMO and POS Benefit
Programs, we are increasing the monthly
capitation rates for primary care physicians (PCP) who are reimbursed on a
capitated basis by 3.0 percent in
aggregate. A larger percentage of the Per Member Per Month rate increase will
be applied to those members
with higher copayments; therefore, the increase at a practice level will vary.
Medicare Advantage HMO
capitation rates will not change in 2014.
- Professional commercial services. For all commercial
Benefit Programs, we are updating our fee
schedule to increase Evaluation & Management codes for new, established, and
preventive care office visits
(CPT® 99201 ? 99215, 99381 ? 99397) billed by your specialty.
These codes will be increased 3.0 percent;
however, the aggregate increase at a practice level will vary based on the mix
of services you provide.
- Professional Medicare Advantage services. For all Medicare
Advantage Benefit Programs, we are updating
our fee schedule to reflect 2014 relative value units for Evaluation &
Management codes (CPT 99201 ? 99240,
99256 ? 99499) for those practices reimbursed on a fee-for-service (FFS)
basis.
Note: As a result of sequestration, the Centers for Medicare &
Medicaid Services (CMS) reduced Medicare
Advantage FFS payments by 2.0 percent as of April 1, 2013. The reduction for
FFS payments that was
incorporated into the August 1, 2013, fee schedule update will continue to
apply unless sequestration reductions
are overturned or revised. In the event that sequestration reductions are
overturned or revised, IBC will adjust the
Medicare Advantage FFS rates, prospectively, within 30 days of the date of the
CMS notification.
For more information
For your reference, we have published a summary of the fee schedule changes
by provider type on IBC
NaviNet® Plan Central. To access these documents, select
Independence Blue Cross from the Plan Central
drop-down menu, and then refer to the Administrative Tools & Resources
section.
If you have any questions regarding these fee schedule changes, please email us or call
us at 1-888-289-3039 and leave a detailed message.
Include your name, contact number, provider number, and
the best time for us to call. You will receive a response within two business
days.
Note: This information does not apply to providers contracted with
Magellan Behavioral Health, Inc., an independent company.
NaviNet® is a registered trademark of
NaviNet, Inc., an independent company.
CPT copyright 2012 American Medical Association. All
rights reserved. CPT is a registered trademark of the American Medical
Association