ASH contracts with Suffolk County employees through BCBS

Please note the following notification from American Specialty Health (ASH) relative to employees of Suffolk County.

Empire BC/BS - Chiropractic Benefit Plan

What you need to know:

  • ASH will be providing certain services on behalf of Suffolk County employees through Empire BlueCross BlueShield (Empire).
  • The effective date is listed as 12/1/19. This is much less than the 90 day notice of change that is supposed to be required of commercial carriers when there is a material change to a provider contract. As a result, if you are an ACN and/or Empire BlueCross BlueShield contracted provider, you may not have been provided with an adequate time frame to determine whether you wish to continue to render chiropractic care to employees of Suffolk County under the terms of the new requirements, and if not, to complete the care and transition of your patients.
  • The current process for Suffolk County employees requires a brief telephone call for authorization of care after the 15th visit. The new process effective 12/1/19 requires an ASH Medical Necessity Review Form after the 10th visit. After 12/1/19 you must follow the ASH submission requirements.
  • Claims continue to be processed via Empire BlueCross BlueShield; however, reimbursement appears to be in accordance with the ASH schedule (not available at the time of this posting). As referenced in the above notice from ASH, please review on ASHLink to see if and how your claim submission and reimbursement will be impacted.
  • Many of you have expressed concern as you have not received any notice relative to this significant process change, and calls to ASH provider services representatives indicated they were unaware of these changes as well. We anticipate that ASH will be educating their service representatives and upload the Suffolk County membership so you can obtain answers to your questions and obtain eligibility information.

If you are a ACN and/or Empire BlueCross BlueShield contracted provider, you should review your participating provider agreement in this context. If you are an ASH contracted provider, you should review your ASH participating provider agreement in this context as well. The law requires that any decision you make regarding your current or future participation with any carrier, managed care organization (MCO) or third-party administrator (TPA), has to be made by you and you alone and cannot be made in collaboration with any other practitioner or provider.

The NYSCA shares members' concerns and will work with key stakeholders to assist with this transition. If you have any additional questions or concerns, please contact the NYSCA insurance committee using our contact form.

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