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ORANGE COUNTY <br />BOARD OF COMMISSIONERS <br />ACTION AGENDA ITEM ABSTRACT <br />Meeting Date: May 17, 2005 <br />Action Age <br />Item No. <br />SUBJECT: Blue Cross Blue Shield of North Carolina Ambulance Service Contract <br />DEPARTMENT: Revenue PUBLIC HEARING: (Y/N) No <br />ATTACHMENT(S): <br />BCBSNC Contract w/Exhibit <br />Table -BCBSNC Fee Schedule <br />Disclosure <br />INFORMATION CONTAGT: <br />Jo Roberson, ext. 2727 <br />TELEPHONE NUMBERS: <br />Hillsborough 732-8181 <br />Chapel Hill 968-4501 <br />Durham 688-7331 <br />Mebane 336-227-2031 <br />PURPOSE: To approve a contract to allow the direct payment of insurance reimbursements to <br />Orange County from Blue Cross Blue Shield of North Carolina (BCBSNC) far Emergency <br />Management ambulance services. <br />BACKGROUND: Since Orange County began charging for the Emergency Management <br />ambulance service in November 1996, insurance claims have been filed on behalf of all clients. <br />Shortly after Orange County began charging for the Emergency Management ambulance <br />service, discussions were held with BCBSNC concerning the County's possible participation as <br />a provider under the company's insurance program. BCBSNC requires a contract agreement <br />as part of this participation, with providers accepting their designated fee as full payment. <br />However, at that time, the reimbursement levels proposed by BCBSNC would not have allowed <br />the County to recoup a reasonable portion of the cost of providing emergency medical services <br />Since that time, BCBSNC has significantly increased the reimbursement rates that they are <br />willing to pay, to the point that the County would receive virtually all of the charges established <br />in the County's EMS fee schedule as approved by the BOCC. <br />BCBSNC is one of the largest insurance providers in this area, with approximately 500 to 600 <br />Orange County ambulance service claims filed annually with BCBSNC as the primary insurer. <br />Approximately 30% to 35% of those clients receive the insurance reimbursement directly from <br />BCBSNC, but for various reasons do not forward those funds to the County for the transport <br />services provided. That results in substantial additional staff effort expended in contacting <br />these clients and attempting to recover monies awed to the County. Under the proposed <br />agreement with BCBSNC, all such payments (including those where BCBSNC is the secondary <br />insurer, following Medicare as the primary insurer) would came directly to the County. <br />This contract will enable Revenue staff to provide better service to citizens by handling the <br />entire financial transaction associated with their ambulance transport. Direct payment from <br />BCBSNC will increase the amount of revenue the County is able to collect, and will allow <br />