If you can’t beat them, join them. A stirring giant ends hibernation in Montana………….
BCBS of Montana was awarded a contract by the State of Montana to administer their Reference Based Pricing plan for state employees. Contract terms expose fees to be charged and Medicare benchmarks upon which to administer claims – BCBS Reference Based Pricing TPA Admin. Agreement Exposed
Legacy RBP vendors should be concerned. Their gravy train may be reaching the end of the line in Montana while the rest of the industry across the country watches.
One legacy RBP vendor charges fees so high that a 120% Medicare benchmark quickly becomes 200% or more when you factor in fees of 12% of billed charges. Another RBP vendor charges a % of savings derived upon the difference between billed charges and allowed amount, driving up a 120% of Medicare reimbursement to 180-190% of Medicare allowable.
Another RBP vendor charges a $40 pepm fee.
BCBS of Montana is charging about $20 pepm admin fee for not only RBP repricing but its inclusive of claim administration too. That’s competitive.
Will other Blue Cross plans follow Montana’s lead?
