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Why an ASC, clinic lost coverage in 2021 

An Illinois clinic lost coverage from Blue Cross and Blue Shield of Illinois and an Idaho ASC lost coverage from CMS in 2021. 

Here's why:

1. In November, 100,000 patients at Springfield (Ill.) Clinic lost coverage after a monthslong dispute between the clinic and Blue Cross and Blue Shield of Illinois. BCBSIL terminated its contract with the 600-physician clinic in June.

BCBSIL posted a statement on its website in June blaming Springfield Clinic for the split. The payer said Springfield Clinic sent an improper 30-day termination notice for Blue Choice and accused Springfield Clinic of "misleading communication" to members.

In August, the Springfield Clinic posted a letter to patients about the change, stating it doesn't anticipate a resolution with BCBSIL and encouraging members to speak with their benefits administrators. 

"We share in our patients' frustration that Blue Cross and Blue Shield of Illinois removed Springfield Clinic as an in-network provider," the clinic said in a statement to ABC 20 in November. "Springfield Clinic is a significant driver of affordable healthcare in central Illinois."

2. In January 2021, CMS terminated its agreement with Nampa, Idaho-based Healing Arts Day Surgery. The center failed to adhere to requirements to participate in Medicare.

Healing Arts Day Surgery is an ASC affiliated with Nampa-based Treasure Valley Gastroenterology. The practice and surgery center are located adjacent to each other and share a building.

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