In a previous article, we talked about the gold that is prompt pay. The Blue Cross Blue Shield (BCBS) antitrust settlement injunctive relief valued at over $17.3 billion (and about $7.55 per BlueCard claim) is the gift that will keep giving for providers across the U.S.

For providers in the settlement, BCBS will be required to pay commercial BlueCard claims that are clean within 30-days or pay interest and provide the clinical rationale for denials and additional information for out-of-area plans. These are tangible improvements that resolve decades of mounting issues with the BlueCard program. But that’s not all. For the first time, providers who participate in the settlement will be able to obtain information about BlueCard claims and patients in the same way they can for local claims and patients.

Providers will benefit from cloud-based technology and a real-time messaging platform to address, among other things:

• Eligibility and coverage
• Authorization rules
• Claims status

Gone are the days of blindly navigating BlueCard claims and waiting on hold with the home plan to obtain basic information. Providers will be well-informed with the tools they need to monitor claims and further, the settlement establishes a “BlueCard executive” at each plan who is empowered to make decisions on behalf of his or her own Blue Plan that cannot be resolved through other means.

If communication through the real-time messaging platform doesn’t resolve a hiccup with a claim, providers can bring issues to their assigned BlueCard executive. The accountability doesn’t end there.

Compliance with the settlement will be overseen by a court-appointed monitoring group. These new features will benefit providers for years to come, but only if they stay in the settlement.

Jeff Gold is an attorney with more than 30 years of industry expertise. The opinions expressed are solely his own and do not express the views or opinions of the Healthcare Association of New York State.