Private Payer Issues

The AAFP advocates to the six largest health plans for family physicians. The AAFP private payer advocacy agenda includes but is not limited to:

  • Holding private payers accountable for a commitment to increase investment in primary care.
  • The need for payers to support practices in value-based contracts.
  • Advocating for reduced or eliminated prior authorizations.
  • The need for administrative simplification by advocating for the adoption of the Core Quality Measures Collaborative’s core measure sets.

Letter to Blue Cross Blue Shield Rhode Island (BCBSRI) Opposing Their Modifier 25 Policy

In response to BCBSRI’s modifier 25 policy, the AAFP sent a letter asking them to re-evaluate their modifier 25 reporting and payment policy.

The letter voices concern that BCBSRI’s modifier 25 policy significantly hampers family physician’s ability to financially operate a medical practice and transition to value-based care. It also is detrimental to patient access to care.

Letter to BCBSRI(177 KB PDF)

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Having a problem with a payer?

Follow these steps:

  1. Contact the payer directly.
  2. Reach out to your local chapter for help.
  3. If the problem persists, contact the AAFP at (800) 274-2237.

See Also