(RALEIGH, N.C.) – State Treasurer Dale R. Folwell, CPA, and the State Health Plan (Plan) announced today that the Plan's new network-provider contracts have been released and are now available for providers to view and sign. The new contracts, recently approved by the Department of Insurance, will form the basis for the new North Carolina State Health Plan Network.
Blue Cross NC, on behalf of the Plan, is responsible for contracting with providers. 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 through a network.
The contract has been posted online and made available for providers to download, sign and submit to Blue Cross NC. Medical providers will have until July 1, 2019 to return their signed contract to be part of the NC State Health Plan Network. Providers that do not return the contract by this date will be considered out-of-network as of January 1, 2020.
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 pricing model tied to Medicare rates. Health care providers will be reimbursed for their services at Medicare rates plus an average of 82 percent.
Under the new network, the Plan will provide increased reimbursement payments to most independent primary care doctors, behavioral health specialists and many rural hospitals. This strategy provides substantial support for those medical professionals that are key health care providers to the Plan's members. This strategy will also save taxpayers almost $258 million and Plan members almost $57 million.
“We're excited to reach the point where we can start giving providers the opportunity to sign up," said Treasurer Folwell. “We've had hundreds of requests for information and a lot of buzz around the new network. I'm very proud of the Board of Trustees, Executive Director Dee Jones and her staff at the State Health Plan and appreciative of Blue Cross NC's work to get us to this stage."
The final contract and rates are the result of months of work by staff at the Plan and Blue Cross NC. The Plan has also responded to the concerns of medical providers over the network's possible impact on rural health care and the impact on provider reimbursement rates. In March, the Plan announced it was changing the reimbursement rates for many rural hospitals, resulting in a $42 million annual increase from the original plan.
Additionally, the Plan decided to phase in the rate changes over a two-year period. First-year rates will reflect $196 million in savings for the Plan with the second year resulting in $62 million in savings. Once the network is established, the Plan will begin working with medical providers to explore other strategies and payment alternatives designed to continue to manage utilization and improve outcomes for its members.
“We're confident that the state's medical community will work with us to create this new network," added Treasurer Folwell. “I would hope that every provider and hospital would want to be part of the network that treats the people who teach their children, protect their homes, and pave their roads."
Providers should visit www.bluecrossnc.com/providers/ncstatehealthplannetwork for more information. Plan members can find more information regarding the Clear Pricing Project at www.shpnc.org.
The State Health Plan, a division of the N.C. Department of State Treasurer, provides health care coverage to more than 727,000 teachers, state employees, current and former lawmakers, state university and community college personnel and their dependents, including non-Medicare and Medicare retirees.