Update on Implementation of the 3M™ Enhanced Ambulatory Patient Grouping (EAPG) Outpatient Reimbursement System
Issue: #407 MAR2019
Blue Cross Blue Shield of North Dakota (BCBSND) has decided to pause the planned July 2019 implementation of the EAPG reimbursement system. The pause means the new outpatient reimbursement system will not be implemented prior to July 2020.
This decision was made based on several factors including:
- Concerns around the Plan’s migration to a new claims adjudication platform and the impact the implementation of the EAPG system could have on the Plan and the provider community during this transition
- The impact the implementation of the EAPG system could have on the launch of the second contracting period for the BlueAlliance program, which will include revisions to address the Plan’s participation in the CMS CPC+ program; and
- Potential impact to providers that legislation at both the State and Federal level regarding Medicaid Expansion, Medicare funding and others may have on provider operations.
BCBSND remains committed to the implementation of the EAPG reimbursement system but wants to do so in a manner that will not place undue stress on the healthcare community.