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ISMA e-Reports, Special Alert, January 8, 2007

Some Hoosier Healthwise physicians unknowingly contracted with Anthem

The ISMA has learned some physicians unknowingly contracted with Anthem for the Hoosier Healthwise program.

Several physicians advised the ISMA they believed they contracted exclusively with only one managed care organization (MCO), but recently learned all their patients had been assigned to Anthem.

Apparently the physicians signed what they believed to be Letters of Intent, but which were in fact amendments and attachments to their Blue Cross and Blue Shield Provider Agreement.

Part of the confusion may have derived from the timing. Although the state did not announce Anthem, MHS and MDWise as the three selected 2007 MCOs until August 2006, physicians were provided these agreements by Anthem as early as May 2006.

This was the same time other MCOs were asking providers to sign documents titled "Letter of Intent." While it’s unclear whether Anthem distributed any document to physicians called "Letter of Intent," it is clear Anthem considers the amendments and attachments to their Provider Agreements as valid contracts. The state assigned patients accordingly.

The ISMA contacted Anthem and the Office of Medicaid Policy and Planning (OMPP) about this issue and will provide additional information as it becomes available.

If you have not already done so, verify the MCOs to which your patients were assigned. If you discover they were assigned to a network with which you do not believe you contracted, or did not intend to contract, verify what documents you signed for each MCO.

If you are unsure about what you signed and did not retain a copy, contact the MCOs and request one. If you still have questions or concerns about network assignments, contact Mark Vonderheit, OMPP operations manager, at mark.vonderheit@fssa.in.gov or (317) 232-4308.

If you have additional questions, call Sandy Distler at the ISMA.

 

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