Blue Shield of California is providing financial support to providers that are in a cash crunch due to COVID-19 disruptions to their elective procedures and other care.
Blue Shield of California is working with two financial-services partners to provide up to $200 million through financing guarantees, advance payments and the restructuring of contracts.
Over the next six months, Blue Shield will make advance payments to providers on anticipated healthcare costs, and will offer favorable repayment terms.
The nonprofit health plan also has taken steps to streamline initial clinical concurrent reviews to reduce provider documentation, and it is easing prior-authorization requirements.
It is waiving prior authorizations for patient transfers of post-acute patients to skilled nursing facilities and extended acute rehabilitation facilities.
It is extending existing prior authorizations for elective procedures from the usual 120 days to 180 days, to give patients time to reschedule their appointments.
Also, Blue Shield is planning to accelerate a patient-billing solution that was introduced in a pilot program in northern California last fall. The payment program was launched with San Francisco-based technology startup OODA Health and northern California providers such as Hill Physicians and Dignity Health. It will be offered to more in-network medical providers across the state.
The initiative enables a provider to receive the patient’s portion of the bill at the time of claim adjudication, thus eliminating the time and expense providers experience to receive payments for member out-of-pocket costs.
WHY THIS MATTERS
Health systems and hospitals are losing about half of their revenue because of the cancellation of elective surgeries and procedures. Some have said that without an immediate influx of cash, they would not be able to make payroll.
The American Hospital Association has more than once urged the federal government to release the $100 billion earmarked for hospitals in the CARES Act stimulus package.
The Trump Administration has said it would like hospitals to use some of the money to cover the cost of caring for uninsured COVID-19 patients and has not agreed to opening up another Affordable Care Act enrollment period, as has been suggested.
THE LARGER TREND
Blue Shield of California is a taxpaying, nonprofit, independent member of the Blue Cross Blue Shield Association.
Blue Shield has been participating in Governor Gavin Newsom’s COVID-19 Testing Task Force that aims to boost coronavirus testing for all Californians, so medical and public health experts can better treat, track and prevent the spread of the virus.
The health plan offers a digital tool at no additional cost for its nearly 350 in-network hospitals to help them triage the influx of patients seeking advice on coronavirus or other medical care via their websites.
It has donated $500,000 to the Oakland COVID-19 Relief Fund and $100,000 to support MedShare, a San Francisco Bay-area nonprofit that donates personal protective equipment to community healthcare providers.
In addition, the Blue Shield of California Promise Health Plan, which serves Medi-Cal and Medicare beneficiaries, is giving $100,000 sponsorship funds to community health providers in Los Angeles and San Diego counties.
ON THE RECORD
“We are arranging hundreds of millions of dollars of support to clinicians and hospitals that are heroically serving Californians on the front lines of this fight,” said Paul Markovich, president and CEO of Blue Shield of California.