DOI Approves Clear Pricing Project Contract

On May 6, the NC Department of Insurance approved the State Health Plan Network Participation Agreement. As many of you know, this agreement has a new fee schedule that will differ than the normal BCBS rates. Per the press release below, the new agreements are set to be sent out by the end of the week.

Department of Insurance Approves
Clear Pricing Project Contract

State Health Plan and Blue Cross NC Prepare to Send
Contracts to Thousands of Medical Providers

(RALEIGH, N.C.) – State Treasurer Dale R. Folwell, CPA, and the State Health Plan (Plan) announced today that the Department of Insurance (DOI) has given final approval to the State Health Plan Network Participation Agreement. The contract will be used by Blue Cross NC to create a custom provider network for the Plan known as the NC State Health Plan Network.

Blue Cross NC is the Plan’s third-party administrator and, as such, contracts directly and indirectly with health care providers, intermediaries and provider organizations to provide, arrange for, or administer the delivery of covered medical services to Plan members. Blue Cross NC will be sending the contract to medical providers across the state for them to join the Plan’s new network.

The new network is being developed as part of the Plan’s Clear Pricing Project (CPP) announced last year. Under CPP, the Plan will move away from a commercial-based payment model to a reference-based, transparent government-pricing model tied to Medicare rates. Health care providers will be reimbursed for their services at Medicare rates plus a substantial profit.

Under the new contract and network, the Plan will provide increased reimbursement payments to most independent primary care physicians, behavioral health specialists and many rural hospitals. This strategy provides substantial support for those medical professionals that are key drivers for members’ health and, at the same time, saves taxpayers almost $258 million and Plan members almost $57 million. The new contract will also provide for clear pricing for medical services allowing members to consume health care instead of it consuming them.

“This approval is an important step in getting state employees, retirees and taxpayers like them who fund this plan, the transparency and prices they’ve deserved for decades,” said Treasurer Folwell. “But for the effort of the staff of the State Health Plan, Blue Cross NC and, most importantly, Commissioner Causey’s staff at the Department of Insurance, this wouldn’t have been possible.”

Contracts (what the Plan will pay for medical services) are scheduled to be sent out by the end of the week. Medical providers will have until June 30 to return the necessary documentation to be part of the State Health Plan Network. The new network will become operational on January 1, 2020.

The State Health Plan, a division of the N.C. Department of State Treasurer, provides health care coverage to more than 720,000 teachers, state employees, current and former lawmakers, state university and community college personnel and their dependents, including non-Medicare and Medicare retirees.

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