More on MAFP's Legislative Efforts
MAFP Legislative Priorities
Michigan Academy of Family Physicians
State Health Care Legislation
July, 2006
Proposed Legislation
BCBSM Reform
This bill would:
- require Blue Cross Blue Shield to have an alternative method for processing claims that are unable to be processed by their automated system.
- require Blue Cross Blue Shield to adopt a policy that procedures for coding and submission of claims be written in clear unambiguous language.
- require Blue Cross Blue Shield to provide reasonable advance written notice for changes to policies related to the coding and submission of claims.
- require Blue Cross Blue Shield to consult with affected organizations to ensure their claims submission and coding policies are clear and unambiguous.
- Upon reasonable written notification by an organization representing physicians, or other affected provider class, Blue Cross Blue Shield shall clarify or eliminate policies or procedures that are ambiguous or confusing with respect to the coding or submission of claims.
- require Blue Cross Blue Shield to pay physicians and other providers 12% interest penalty for delays caused by violating the aforementioned provisions. Would also allow the Commissioner of Insurance and Financial Services to fine Blue Cross Blue Shield $5,000 for each violation of the statute.
- require public disclosure of medical review criteria as well as the criteria used to initiate an audit of a physicians practice
- eliminate the evidence of need requirement for freestanding surgery centers.
Any Willing Provider:
This bill would force BCBSM and other health corporations to allow any doctor to participate in their programs if they are willing to sign the appropriate contract. These organizations would not be able to simply terminate physician or health facility contracts indiscriminately or according to their own criteria.
Prohibit “Price Fixing”:
This bill would prohibit large health corporations from arbitrarily establishing reimbursement rates for physician and health organization services.
To See Key Legislation Important to Michigan Family Physicians, click here!
To See All Legislation Monitored by the Michigan Academy, click here!
2164 Commons Parkway
Okemos, MI 48864
Ph: 517-347-0098 or 800-833-5151
Fax: 517-347-1289
info@mafp.com
Links | Contact Us