Small Group Blues Enroll - Arkansas Blue Cross and Blue Shield

ARKANSAS BLUE CROSS AND BLUE SHIELDSMALL GROUP BLUESENROLL GROUP ADMINISTRATOR’S MANUALSection 15 - THE BLUE BOOKThe Blue Book is a periodically published directory of all health care professionals andfacilities that agree to accept Arkansas Blue Cross and Blue Shield’s allowances.The agreement with physicians is called the Preferred Payment Plan (PPP). Toestablish payment rates for physicians and other health care professionals, ArkansasBlue Cross has established and maintains a Schedule of Maximum Allowances.Arkansas Blue Cross utilizes the Resource Based Relative Value System (RBRVS) as aguide in establishing fees. RBRVS has been developed with input from thousands ofproviders, and has become industry standard for establishing physician payments.Providers who appear in The Blue Book have agreed to accept the Arkansas Blue Crossfee schedule as their maximum payment, and cannot collect amounts greater than theschedule for covered services to those insured by Arkansas Blue Cross.With hospitals, the agreement is known as the Hospital Reimbursement Program.Arkansas Blue Cross determines hospital payment rates using the Diagnosis RelatedGroups (DRG’s) classification system which groups hospital patients according to similardiagnostic criteria and other characteristics.By having these agreements with providers , Arkansas Blue Cross assures that theagreed payment level is paid directly to the physician or the hospital and the customercannot be charged except for deductibles, co-payments or non-covered servicesestablished in the benefit contract. For you, the most important aspect of these uniquecontractual relationships is cost predictability.Small Group BluesEnroll R 10/25/07 39