19 recent payer, provider contract disputes, renewals

The following payer-provider contract terminations and resolutions occurred during the past three months. 

1. Providence Health & Services ends contract with Premera Blue Cross
Renton, Wash.-based Providence Health & Services terminated its contract with Premera Blue Cross after disputing reimbursement rates and other terms.

2. Piedmont, UnitedHealthcare fail to reach contract agreement
Atlanta-based Piedmont Healthcare facilities are out-of-network for UnitedHealthcare commercial policyholders as of July 1.

3. United, UNMH split on Medicaid patients, cite reimbursement issues
University of New Mexico Hospital in Albuquerque and health insurance giant UnitedHealthcare terminated a contract agreement for services provided to Medicaid patients.

4. Hackensack University Medical Group goes out of network with UnitedHealthcare
UnitedHealthcare dropped coverage with Hackensack (N.J.) University Medical Group six months in advance of its exit from the state's Affordable Care Act market.

5. Indiana taps CareSource for Medicaid services
The Indiana Family and Social Services Administration selected CareSource to administer healthcare services for those enrolled in the Healthy Indiana Plan and Hoosier Healthwise programs, effective January 2017.

6. Premier Health hospitals no longer in CareSource's Just4Me network
Effective Aug. 1, CareSource will cease paying Dayton, Ohio-based Premier Health for most services under its Just4Me health plans.

7. Ellenville Regional still in network for Empire BCBS members
Ellenville (N.Y.) RegionalHospital confirmed the hospital is an in-network facility for Empire Blue Cross Blue Shield policyholders.

8. CarePoint's Hudson hospitals now out-of-network with Horizon
All three HudsonValley hospitals operated by Jersey City, N.J.-based CarePoint Health terminated in-network rate agreements for Horizon Blue Cross Blue Shield members.

9. Patient First clinics again accepting Anthem health plans
After a four month hiatus, Richmond, Va.-based Patient First will provide care services at in-network rates to Blue Cross Blue Shield members.

10. Empire BCBS, HealthAlliance to split after unsuccessful negotiations
Empire Blue Cross Blue Shield and HealthAlliance of the HudsonValley in Kingston, N.Y., failed to reach an agreement before their in-network contract expired.

11. Blue Cross downgrades UAB Hospital to tier 2
Blue Cross and Blue Shield of Alabama downgraded UAB Hospital in Birmingham, Ala., from Tier 1 to Tier 2 status, citing new tier criteria based on hospitals' spending.

12. Integrated Health Partners, Molina Healthcare partner to expand coverage
Integrated Health Partners of Southern California's health centers can serve patients covered by Molina Healthcare's health plans for individuals eligible for Medicare.

13. NC hospital, BCBS reach contract agreement
Blue Cross Blue Shield reinstate Jacksonville, N.C.-based Onslow Memorial Hospital as part of the insurer's low-priced network May 1.

14. Ochsner, UnitedHealth repair agreement through January
UnitedHealthcare and New Orleans-based Ochsner Health System reached a contract agreement to continue providing in-network service rates to Louisiana residents through January 2017.

15. Highmark downgrades UPMC Jameson tier status
Patients with Highmark Blue Cross/Blue Shield's Community Blue Flex plan will pay more for care services at UPMC Jameson than they did before the single hospital health system merged with Pittsburgh-based UPMC in May.

16. UnitedHealthcare, Obstetrix contract impasse leaves patients without coverage
A contract dispute between UnitedHealthcare and a physicians' group that manages high-risk pregnancies left thousands of parents without coverage for their sick babies.

17. HCA, BCBS of Texas renew contract
Hospital Corporation of America and Blue Cross Blue Shield of Texas reached an agreement to keep all the Nashville, Tenn.-based hospital chain's Texas medical facilities in network.

18. Butler Health System, Highmark forge new multiyear deal
Highmark Blue Cross Blue Shield and Butler (Pa.) Health System finalized a multiyear contract.

19. Highmark, Bayhealth resolve contract dispute
Bayhealth Medical Center in Dover, Del., and Highmark Blue Cross Blue Shield of Delaware reached an agreement to keep Bayhealth facilities in-network for the insurer's policyholders.

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