Anthem Administrative Services Agreement

We know that the negotiations have caused uncertainty for you and we thank you for your patience when both parties have worked on an agreement. The Anthem Submission also contains amendments to section 4.18 of the contract that affect reimbursement rates for workers` compensation services. Previously, the contractual language indicated that physicians would receive the lower part of the California Division of Workers` Compensation Official Medical Fee Schedule (OMFS) or the byer prudent settlement in Appendix B. The new language requires Anthem to reimburse 85 percent of the OMFS, fees charged by physicians, or the fee schedule for the Prudent Buyer in Appendix B. Contact: Reimbursement Helpline, (888) 401-5911 or We are pleased to inform you that Anthem Blue Cross has entered into a new agreement with Dignity Health with retroactive effect to July 15, 2021. PPO UC plan members can continue to have access to Dignity Health`s facilities and medical groups throughout California. And any benefits that go beyond the Medicare services made available to Anthem members by Dignity Health in network hospitals and medical groups during the contract termination period (July 15 to August 17) and the current duration will be covered in terms of the network performance of your plan. To help physicians understand their rights when a health plan has sent a notice of a substantial contract change, CMA has published “Contract Changes: An Action Plan for Physicians.” The guide, which is made available free of charge to CMA members, discusses the options available to physicians when faced with a substantial change in a contract. In addition, CMA has developed a worksheet with financial implications to help physicians calculate the net impact of scale changes on their practice and make informed decisions. The new rates are available on the Availity website by choosing “Pay Spaces” and then “Anthem Blue Cross” (select Education and Reference Center> Administrative Support> Prudent Buyer Fee Schedule Update).

Physicians with questions about communication can speak to Anthem Blue Cross Network Relations staff in Physicians are encouraged to carefully review any proposed changes to the health plan or medical group/IAP contracts….

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