Anthem Blue Cross recently issued a systemwide notice to over 70,000 physicians with an amendment to its Prudent Buyer Plan Participating Physician Agreement that will require contracted physicians to maintain privileges with at least one participating ambulatory surgery center (ASC). This policy goes into effect September 1, 2023.  

The changes, reflected in the addition of language to the Prudent Buyer Agreement, indicate that unless Anthem agrees in advance in writing, physicians must maintain privileges at a licensed, in-network ASC. Currently, Anthem only requires physicians to maintain hospital privileges at an in-network hospital.

Anthem has advised the California Medical Association (CMA) that this requirement is intended to ensure that all participating physicians who perform surgical procedures appropriate for an ASC site-of-service have privileges at an in-network ASC facility.

New providers wishing to join Anthem’s network will now be required to report both the hospitals and ASCs at which they have privileges as part of the application process. Existing contracted providers can report new privileges and changes to ASC privileges through the current process they use for submitting demographic changes – the Provider Maintenance Form, located under the Contact Us page on the Provider Page of Anthem.com/CA.

Physicians who are unsure whether or not they are affected by this change, those who wish to request an exception or those who have general questions about the amendment, can contact their assigned Anthem Blue Cross Provider Relationship Manager or utilize the Email a Provider Experience Associate via the Contact Us form on the Anthem.com/CA webpage.

As always, physicians are encouraged to carefully review all proposed amendments to payor contracts to fully understand how the changes will affect their practice.

Practices experiencing challenges with this contract amendment are encouraged to contact the California Medical Association at (800) 786-4262 or economicservices@cmadocs.org.