What's Inside: CAA update: Capital Blue Cross to submit all drug cost reporting files for fully insured and small group ASO customers | No Surprises Act — Independent dispute resolution (IDR) | Health reimbursement arrangements (HRA) administration applications | Pet insurance available to members through Blue365
CAA update: Capital Blue Cross to submit all drug cost reporting files for fully insured and small group ASO customers
As Capital Blue Cross continues to interpret CMS’ guidance about the CAA requirement for drug cost reporting, we have reevaluated how we will provide reports for fully insured groups and small ASO groups for benefit offerings in 2020 and 2021. We will now submit D1-D8, P1, and accompanying P2 files directly to CMS on their behalf.
No Surprises Act — Independent dispute resolution (IDR)
As part of the Consolidated Appropriations Act (CAA), the No Surprises Act protects individuals from surprise medical bills for emergency services, out-of-network air ambulance services, and certain nonemergency services provided by out-of-network providers at in-network facilities.
The No Surprises Act also provides access to an independent dispute resolution (IDR) process for providers and plans who cannot reach an agreement on payment. If the IDR process is triggered, an external IDR entity (arbiter) will be assigned to determine the amount the provider must accept as final payment — either the amount offered by the plan or the amount requested by the provider.
Per large group ASO contracts, costs for IDR charges will be applied in 2023 as disputes reach resolution. While this mandate went into place on January 1, 2022, and our contracts reflected the changes for that date and beyond, we have reached the point where IDR disputes are reaching resolution. Any applicable claim adjustment and costs associated with the IDR process will be applied to large ASO groups’ monthly statements.
Health reimbursement arrangements (HRA) administration applications
HRA options may differ between standard and custom products, and may change from time to time. The HRA administration forms have been updated to reflect these changes for 2023. HRAs are offered in all commercial group market segments except for small group PPACA.
Pet insurance available to members through Blue365
Beginning January 1, 2023, members can take advantage of a 10% discount through Fetch Pet Insurance available on Blue365®.
Consolidated Benefits, Inc. is sunsetting the pet insurance currently offered through Embrace. Members currently contracted through Embrace can keep their plan since Embrace handles all renewals directly with their policyholders.
Your producer relations team
Capital Blue Cross has adopted a team approach to support you, as we collaborate to enhance business relationships, foster your growth through education and incentives, and actively support the communities we serve. The Producer Relations team thanks you for your commitment and hard work. Reach out whenever you need them.