Wisconsin Anthem BCBS Latest to Implement Rate Alignment Strategy

July 2019 ~

Anthem Blue Cross Blue Shield (BCBS) continues to implement its “rate alignment” strategy aimed at lowering the reimbursement that hospital-based providers receive to the same rates paid to independent labs and pathologists, announcing the most recent rate changes for plans in Wisconsin –effective August 1.

Since November of 2018, the insurer has announced and/or implemented similar rate changes have been at nine other Anthem plans plus three other non-Anthem BCBS plans in Alaska, Washington and West Virginia.

“Rate Alignment” Changes Announced for State BCBS Plans

Anthem BCBS of Missouri………………………………………………………………………………. November 1, 2018

Premera BCBS of Alaska……………………………………………………………………………………January 1, 2019

Premera Blue Cross of Washington……………………………………………………………………. January 1, 2019

Anthem Blue Cross of California (Prudent Buyer Plan)…………………………………………July 1, 2019

Anthem BCBS of Ohio………………………………………………………………………………………..July 1, 2019

Anthem BCBS of Indiana……………………………………………………………………………………July 1, 2019

Anthem BCBS of Georgia…………………………………………………………………………………..July 1, 2019

Anthem BCBS of Wisconsin……………………………………………………………………………….August 1, 2019

Anthem BCBS of Kentucky (excluding 88300-88309)……………………………………… September 1, 2019

Anthem BCBS of Virginia………………………………………………………………………………. September 1, 2019

Highmark BCBS of West Virginia…………………………………………………………………… September 1, 2019

Anthem BCBS of New Hampshire…………………………………………………………………… September 1, 2019

Anthem Empire BCBS of New York……………………………………………………………….. January 1, 2020

While the rate changes vary from state to state, the insurer’s rates for most pathology services paid to hospital-based technical labs and pathologists are being reduced by roughly 25% to 50%, with clinical lab test reimbursement being set at approximately 40-50% of the 2019 Medicare Clinical Lab Fee Schedule (CLFS).

Anthem plans in Virginia, West Virginia, New Hampshire, as well as BCBS plans of Kentucky are the latest plans to announce changes that become effective September 1. Rates for CPT 88300-88309 are not changing. Rates for CPT codes 88342-26 are set to decline by 68% to $16.34. CPT code 88342-TC will be lowered by 35% to $29.66.

CPT® is a registered trademark of the American Medical Association.

Source(s): Anthem Inc.; July 2019 Anthem Provider News – Wisconsin; Vachette Pathology; Klipp, J. D. (2019, July). Anthem Continues to Push Through “Rate Alignment” Strategy. Laboratory Economics, Volume 14 (No. 7), pp. 7.

 

 

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