Employers

Group Administrator's Manual

The Blue Book

The Blue Book is a periodically published directory of all health care professionals and facilities that agree to accept Arkansas Blue Cross' allowances.

The agreement with physicians is called the Preferred Payment Plan (PPP). To establish payment rates for physicians and other health care professionals, Arkansas Blue Cross has established and maintains a Schedule of Maximum Allowances. Arkansas Blue Cross uses the Resource Based Relative Value System (RBRVS) as a guide in establishing fees. The RBRVS was developed with input from thousands of providers, and has become industry standard for establishing physician payments. Providers who appear in The Blue Book have agreed to accept the Arkansas Blue Cross fee schedule as their maximum payment, and cannot collect amounts greater than the schedule 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 Related Groups (DRGs) classification system, which groups hospital patients according to similar diagnostic criteria and other characteristics.

By having these agreements with providers, Arkansas Blue Cross assures that the agreed payment level is paid directly to the physician or the hospital and the member cannot be charged except for deductibles, copayments or non-covered services established in the benefit certificate. For you, the most important aspect of these unique contractual relationships is cost predictability as well as savings.

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