Provider Stability Act

When an insurer makes changes to a provider manual, reimbursement rule or policy, the insurer must disclose or identify that information at least 60 days before the change takes effect. Here’s how we’ll communicate these changes to you:

• We’ll use bold print or a larger font to identify changes in our Provider Manuals.
• We’ll send you a separate communication about reimbursement rule and policy changes and their effective dates.

Insurers must give you at least 90 days’ notice about any fee schedule changes and effective dates. We’ll send the required notice to your dedicated email address or as otherwise mentioned in your BlueCross contract. We cannot make fee schedule changes more than once in a 12-month period. However, a health insurance carrier and a hospital may agree to changes in writing.

Exceptions include changes to your:

• Fee schedule effected by the state or federal government
• Reimbursement for drugs, immunizations, injectables, supplies or devices if you and the health insurance carrier or PBM agreed reimbursement will be based on an index not established by the health insurance carrier
• Reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and the carrier or PBM have previously agreed to reimbursement based on maximum allowable cost pricing
• CPT®, HCPCS, ICD or other code sets recognized or used by CMS that a health insurance carrier used in creating your fee schedule
• Revenue codes as established by the National Uniform Billing Committee (NUBC)
• Fee schedule due to one or more of the following if previously agreed to in a provider’s agreement with a health insurance carrier:
• Payments made to you are based on values or quality measures explicitly described in your agreement and intended to improve the quality of care provided to our members
• Escalator or de-escalator clauses
• Provisions that require adjustments to payment due to population health management performance or results
• Tennessee Healthcare Innovation Initiative (THCII)