Issue link: https://beckershealthcare.uberflip.com/i/717576
50 CFO / FINANCE 19 Recent Payer-Provider Contract Disputes, Renewals By Brooke Murphy T he following payer-provider contract terminations and resolutions occurred since May. 1. Renton, Wash.-based Providence Health & Services terminated its contract with Prem- era Blue Cross aer disputing reimbursement rates and other terms. 2. Atlanta-based Piedmont Healthcare facili- ties are out-of-network for UnitedHealthcare commercial policyholders as of July 1. 3. University of New Mexico Hospital in Al- buquerque and health insurance giant Unit- edHealthcare terminated a contract agreement for services provided to Medicaid patients. 4. UnitedHealthcare dropped coverage with Hackensack (N.J.) University Medical Group six months in advance of its exit from the state's Affordable Care Act market. 5. e Indiana Family and Social Services Ad- ministration selected CareSource to admin- ister healthcare services for those enrolled in the Healthy Indiana Plan and Hoosier Health- wise programs, effective January 2017. 6. Effective Aug. 1, CareSource will cease pay- ing Dayton, Ohio-based Premier Health for most services under its Just4Me health plans. 7. Ellenville (N.Y.) RegionalHospital con- firmed the hospital is an in-network facility for Empire Blue Cross Blue Shield policyhold- ers. 8. All three HudsonValley hospitals operated by Jersey City, N.J.-based CarePoint Health terminated in-network rate agreements for Horizon Blue Cross Blue Shield members. 9. Aer a four month hiatus, Richmond, Va.- based Patient First will provide care services at in-network rates to Blue Cross Blue Shield members. 10. Empire Blue Cross Blue Shield and HealthAlliance of the HudsonValley in Kings- ton, N.Y., failed to reach an agreement before their in-network contract expired. 11. Blue Cross and Blue Shield of Alabama downgraded UAB Hospital in Birmingham, Ala., from Tier 1 to Tier 2 status, citing new tier criteria based on hospitals' spending. 12. Integrated Health Partners of Southern California's health centers can serve patients covered by Molina Healthcare's health plans for individuals eligible for Medicare. 13. Blue Cross Blue Shield reinstated Jackson- ville, N.C.-based Onslow Memorial Hospital as part of the insurer's low-priced network May 1. 14. UnitedHealthcare and New Orleans-based Ochsner Health System reached a contract agreement to continue providing in-network service rates to Louisiana residents through January 2017. 15. Patients with Highmark Blue Cross/Blue Shield's Community Blue Flex plan will pay more for care services at UPMC Jameson than they did before the single hospital health system merged with Pittsburgh-based UPMC in May. 16. A contract dispute between UnitedHealth- care and a physicians' group that manages high-risk pregnancies le thousands of par- ents without coverage for their sick babies. 17. Hospital Corporation of America and Blue Cross Blue Shield of Texas reached an agree- ment to keep all the Nashville, Tenn.-based hospital chain's Texas medical facilities in net- work. 18. Highmark Blue Cross Blue Shield and But- ler (Pa.) Health System finalized a multiyear contract. 19. Bayhealth Medical Center in Dover, Del., and Highmark Blue Cross Blue Shield of Dela- ware reached an agreement to keep Bayhealth facilities in-network for the insurer's policy- holders. n Providence Health & Services Ends Contract with Premera Blue Cross By Morgan Haefner R enton, Wash.-based Providence Health & Services will not renew its contract with Mountlake Terrace, Wash.-based Premera Blue Cross after disputing rates and other terms. Effective Jan. 1, Providence, Seattle-based Swedish Medi- cal Center, Richland, Wash.-based Kadlec Regional Medi- cal Center, Seattle-based Pacific Medical Centers and their physicians and clinics will be out-of-network with all Prem- era policyholders. Up to 500,000 people could be affected, The Seattle Times reported, though Providence said no Medicare re- cipients will be affected. Providence also said in a statement it "asked Premera to pay a fair rate that is consistent with other payers in the commu- nities" it serves, but Premera was unwilling to agree. In response, Premera argued it has "committed to more aggressively control costs, improve the quality of care with performance-based payments, and enhance the patient experience," and "invited Providence to similarly meet the needs of customers in alignment with this community stan- dard." Premera said it is open to working with Providence on a new contract. Providence said it believes there is opportunity for negotiation but chose to share the news for patients as they make decisions about their healthcare plans for 2017. Premera policyholders will remain in-network at Providence facilities and clinics until Dec. 31 unless an agreement is reached before then. n