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Update Regarding Proposed Changes to Multiple Radiology Reimbursement Policy

As you may know, Blue Cross and Blue Shield of North Carolina (BCBSNC) has undertaken efforts in the past year to implement a new corporate medical policy (the Radiology CMP) addressing the reimbursement of certain radiology claims.  We estimate implementation of this policy would save consumers approximately $16 million per year by aligning with national standards for reimbursement of multiple radiology scans.

Initially, BCBSNC provided notice of the Radiology CMP as a change in our reimbursement policies.  Several provider associations objected and argued that BCBSNC could implement the policy only as an amendment to its provider contracts.  BCBSNC disagreed.  But, after receiving a contrary interpretation from the North Carolina Department of Insurance (NCDOI), BCBSNC requested a hearing before the NCDOI, which is still pending.  Under protest, BCBSNC provided notice of the Radiology CMP as a contract amendment.  However, the majority of providers contacted by BCBSNC objected to the new policy, thereby blocking implementation of the policy as an amendment to their provider contracts.

Regrettably, the number of providers who objected to the Radiology CMP under the contract amendment process was sufficient to prevent implementation of the policy as a contract amendment.  As a result, BCBSNC will continue to maintain a hold on implementation of this policy (“Radiology Services Reimbursement Policy”) and will not at this time apply it to claims submitted by any providers, including those who agreed to its implementation as a contract amendment.  After resolution of the hearing at the NCDOI, BCBSNC will re-evaluate and inform you of any change in the status of the current multiple radiology policy.