BIRMINGHAM, AL – Healthcare economist experts working on the Blue Cross Blue Shield antitrust case for the past decade have calculated the value for the settlement’s injunctive relief in excess of $17.3 billion over the first ten years of its implementation. In addition to a $2.8 billion monetary payment, the significant benefits of the settlement’s injunctive relief include specific commitments relating to transparency, efficiency, and Blue Plan accountability. Some of the key behavioral changes to the Blue Cross Blue Shield system include:
- Improved claims processing
- Prompt payment requirements
- Improved adjudication for denied claims, including a common appeal form
- Improved determination of patient eligibility and plan benefits
- Improved options for telehealth
- Enhanced data exchange capabilities between Blue plans, physician offices, and EHR vendors
- Faster response to inquiries regarding electronic claims submission status
- A mandated offering of at least one Value-Based Care payment model for all Blue plans
- Improved and more transparent process for determining patient attribution
- Negotiated standards for performance measurement
- Improved national guidance on prior authorization standards consistent with the Consensus Statement previously agreed to by the BCBSA with AHIP, the AMA, and the AHA.
These major changes will create substantial reductions in system inefficiencies that have long burdened and drained the resources of Providers and their staffs. The changes made will give Providers new and fairer opportunities to contract with Blue Cross entities.
Read the full press release here.
Background: Robert B. Roden, Esq. is a member of the Litigation Committee for the Provider Plaintiffs. He, along with David D. Shelby, Esq. and C. Don Freeman, Esq., and their law firm Shelby Roden LLC, have worked on behalf of Providers from the beginning of this case in 2012.