Federal Employee Program Payment challenges continue

Over the past year, CDA has received phone calls from member dentists about dental claim payment issues with the Blue Shield of California Federal Employee Program. According to information Blue Shield provided to CDA, the payment delays initially were caused by a system migration at Blue Shield. The system migration took more than six months to be resolved, resulting in a large backlog of outstanding claims that directly affected the turnaround time for claim payments.

While the migration issue appears to be resolved, as of late, the Federal Employee Program is demanding credentialing documentation from noncontracted dentists, which is further delaying payment to the noncontracted dentists. CDA reached out to Blue Shield of California to obtain information and seek a resolution that ensures more timely payment for dentists who treat federal employees. Blue Shield of California has assured CDA that the Federal Employee Program team is diligently working to ensure that dentists who deliver care to the Blue Shield FEP membership, whether the dentist participates in the Blue Shield FEP network or not, are compensated in a timely and proper manner in accordance with the Federal Employee Program plan design. 

CDA will continue to advocate on behalf of members on this latest payment issue and will provide updates as appropriate. Dentists who are experiencing payment challenges with Blue Shield of California Federal Employee Program are encouraged to utilize the provider dispute resolution process available to all providers. The "Provider Dispute Resolution – Professional" form can be found on Blue Shield's website.

For more information, contact CDA Practice Support at 800.232.7645.

Related Items

As the dental marketplace continues to change, hiring associates and having a multidentist practice is increasingly more common. CDA Practice Support frequently receives inquiries from members regarding how to correctly bill for associate dentists providing treatment in their practice.

There is an ongoing trend within health care toward integration and consolidation of health care delivery systems. This trend is reflected in provisions of the federal Affordable Care Act, such as the envisioned coordination of care provided under a single entity, the “Accountable Care Organization.”