Skip to main content

Individual Provider Recontracting Initiative

Date:
June 26, 2020

To: All Providers

We will be amending and restating our existing contracts. We will begin sending these to all directly contracted individual providers starting next month. The New York State Department of Health (DOH) requires that each provider sign and return these.

The unique identification number in the footer of your current contract had not been previously approved by DOH, and therefore requires that we secure a provider signature from all of our individual network providers (per NPI) on the amended and restated contracts.

Other changes were made as follows:

  • The Centers for Medicare and Medicaid Services (CMS) has revised the Government Programs Compliance Provisions to ensure compliance with current regulations and that all obligations of the provider are explicit. An updated version of the “Government Program Compliance Provisions” attachment has been added to your contract.
  • The “Notices” section of your contract was updated, and a new section regarding compliance with provider manual(s) was added to your contract.

Contract Delivery

The contracts need to be signed by each individual provider who is contracted with us. You or your practice will receive these contracts through the mail, and the name of the provider will be pre-populated in the contract. Once signed, you may either scan the contract and email it to us at Initiative@bsneny.com or mail it to us in the enclosed postage pre-paid envelope.

Thank you for helping us meet this DOH requirement by signing and returning these new contracts as quickly as possible.

Recent Articles

  • Pregnancy During the COVID-19 Pandemic
    For many pregnant women, the COVID-19 pandemic has raised new questions about how to get the care they need while staying healthy. According to the Centers for Disease Control and Prevention (CDC), pregnant women might be at a higher risk for severe illness or hospitalization if they contract COVID-19 and they may need additional support during these unprecedented times. Here, we offer guidance and resources for your pregnant patients.
  • Reminder: Ancillary Claims Must Be Approved by Supervising Physician
    To ensure proper processing and avoid denials or rejections, ancillary claims, lab orders, specialty pharmacy prescriptions, and referrals for your BlueShield patients must be completed in full by the supervising physician of record.
  • Drug Therapy Guidelines Updates July 2020
    New drug therapy guidelines have been developed with the guidance of our Pharmacy and Therapeutics Committee. These guidelines will be posted by August 1 and will be effective September 1. Five medications will require preauthorization.
  • Individual Provider Recontracting Initiative
    We will be amending and restating our existing contracts. Starting next month, all directly contracted individual providers will be sent an updated contract. The New York State Department of Health (DOH) requires that each provider sign and return their amended/restated contract.
  • New Digital Provider and Facility Reference Manual
    We’ve upgraded our Provider and Facility Reference Manual, which is now available in digital format. The new manual offers a better, more interactive user experience. Here, we highlight some of the new features.

Working with Us

Additional Resources

We want to hear from you! Have a topic request for the next Blue Bulletin? Email us

Stay in Touch! Sign up to receive emails for provider news and information