ASH Blue Shield of CA Update

Blue Shield of CA will begin to utilize ASH for a “significant” number of their PPO plans January 1, 2020. But the use of “significant number” is not clear as to what plans they are indicating is it more than 50% less than etc. However, conversation with ASH “provider relations” they indicated it would include “individual off-exchange plans” and Covered CA.

This is still is not very clear but taking it at face value individual plans that are “off exchange” would be only individual purchasers of insurance, not group plans. Covered CA plans are the exchange plans and they are only sold to individuals and small employers (under 25 employees).

This appears to not be the majority of plans under ASH as the bulk of Blue Shield of CA is from large employer plans. It is still a large number of policies but not the majority.

It is also indicated that providers already enrolled with Blue Shield of CA will remain as participating providers come January 1, 2020. However, to eligible as “in network” with the plans affiliated with ASH you must also enroll with ASH.

The fees are not the standard ASH $26 inclusive visit based on what has been published. There will be allowances for E&M codes $21-43 (note BS of CA this year has only been allowing $20). CMT codes $28-30, all therapies $11, and allowances for strapping, home visits, online evaluation, review of records, x-rays, and urinalysis.

It is not required you join ASH to be “in network” with Blue Shield of CA except for the plans that directly contract and at this time it would appear to not be the majority


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