Settlement Timeline

NEPHO Health Plan Settlement Timeframe:

Contracts:

LCPN
·     AllWays Health Partners
·     Blue Cross Blue Shield (BCBS)
·     Cigna
·     Harvard Pilgrim Health Care (HPHC)
·     Tufts Health Plan (THP)

LCP-ACO
·     Medicare ACO
·     MassHealth ACO

NEPHO
·     Boston Medical Center (BMC)
·     Commonwealth Care Alliance (CCA)
·     Fallon
·     Tufts Health Public Plans
·     Tufts Medicare Preferred (TMP)
·     UniCare

Settlement Details:

  • The settlement for 2019 LCPN payor contracts has deviated from normal delivery due to Covid-19. A 2019 withhold distribution was made in April 2020 and an interim 2019 payor contract settlement and withhold distribution was made in June 2020.  The final 2019 payor contract settlement is expected to be distributed in February 2021.
  • The settlement for the 2019 NEPHO TMP contract is expected in October 2020.
  • The settlement for 2020 LCPN payor contracts is expected in February 2022. NEPHO 2020 payor contract settlements, except TMP, will be included with the LCPN settlement in February 2022.  2020 NEPHO TMP contract settlement is expected in October 2021.
  • Several payors withhold funds from providers in the event of a loss in a risk contract. These withhold funds are returned from the payors to LCPN, with their settlements.  NEPHO returns the withhold funds with settlement distribution, or earlier, if NEPHO determines it is prudent to do so.
  • The following contracts take a withhold: BCBS, Fallon, HPHC, and Tufts
  • New risk contracts will be held through Beth Israel Lahey Health Performance Network (BILHPN) as of January 1, 2021. At this time, NEPHO expects our BCBS and HPHC 2021 contracts to be held through BILHPN, with their contract settlement timelines to be determined.

Minimum Requirements:

NECoMG sets certain minimum requirements of its physicians, in order to participate in payor contract settlements.        Click here to be directed to the current year’s requirements.