Health plans terminate relationship with Vantage Medical Group The California Medical Association (CMA) has learned that two health plans, the Inland Empire Health Plan (IEHP) and Molina Healthcare, are terminating their contracts with Vantage Medical Group. Two other plans, Blue Shield of California and Care1st Health Plan, have issued notices of material breach with an intent to terminate. The plans have filed requests with the California Department of Managed Health Care (DMHC) to transfer their enrollees to other delegated groups. According to IEHP’s block transfer filing with DMHC, Vantage engaged in conduct that resulted in the inappropriate delay, ... July 11, 2018 General, Managed Care, Medi-Cal Blue Shield, Commercial Payors, Department of Managed Health Care, DMHC, Payor Contracting 0 0 Comment Read More »
Blue Shield implements system fix for AB 72 claims Last year, the California Medical Association (CMA) worked with Blue Shield of California to correct two issues affecting accurate payment of claims subject to the state’s new out-of-network billing and payment law (AB 72). The issues were identified as being due to manual claim processing errors, because the payor had not yet updated its system to allow automated processing of claims subject to AB 72. Blue Shield recently announced it was implementing a system update on June 28, 2018, that will allow claims subject to AB 72 to be processed ... July 11, 2018 General, Managed Care AB 72, Blue Shield, Out of Network Care 0 0 Comment Read More »
Payors report system changes to comply with AB 72 When California’s new out-of-network billing and payment law (AB 72) took effect on July 1, 2017, the California Medical Association (CMA) began receiving calls from physician offices concerned that Anthem Blue Cross and Blue Shield of California were not correctly paying claims. In both cases the incorrect payments were linked to manual processing of AB 72 claims. CMA worked with Blue Shield to ensure affected claims through October of 2017 were automatically reprocessed. Blue Shield also committed to conducting weekly audits to catch any additional claims that were processed erroneously. ... April 5, 2018 General, Managed Care Anthem Blue Cross, Blue Shield, Economic Advocacy, AB 72, Out of Network Care 0 0 Comment Read More »
Blue Shield updates fee schedule effective December 1 Blue Shield of California recently announced changes to its physician fee schedule that will take effect December 1, 2017. While the notice indicated that the new rates would be available on the Blue Shield website by October 1, CMA has learned that Blue Shield experienced technical difficulties that will delay the availability of the new rates on the website, until October 9, 2017 (tentatively). The rates will be located under "Helpful Resources," then “Professional Fee Schedule,” then click “Search the Claims Fee Schedule” using a “Date of Service” of December ... October 13, 2017 Managed Care Blue Shield, Payor Contracting 0 0 Comment Read More »
Health plans begin transitioning patients from troubled Nivano The California Medical Association (CMA) has learned that two health plans—Blue Shield and UnitedHealthcare (UHC)—have recently terminated their delegated agreements with Nivano Physicians Medical Group and are in the process of transferring patients from Nivano to alternative networks. Nivano, also known as Northern California Physicians Medical Group with enrollees in Placer, Nevada, Sacramento, Yuba and Colusa counties, is currently on a corrective action plan with the Department of Managed Health Care (DMHC) for failure to meet financial solvency criteria. CMA has also received a surge of complaints about delays in ... August 9, 2017 Managed Care Blue Shield, UnitedHealthcare 0 0 Comment Read More »
Updated payor profiles for 2017 now available The California Medical Association’s (CMA) Center for Economic Services is publishing updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, UnitedHealthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration; a description of the plan’s dispute resolution process; and the name and contact numbers for medical directors, provider relations, and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free of charge ... August 1, 2017 CMA, Managed Care, Medi-Cal, Medicare Aetna, Anthem Blue Cross, Blue Shield, Cigna, Health Net, Insurance, Medi-Cal, Medicare, Noridian, Payor, Payor Profiles, Running a Practice, UnitedHealthcare 0 0 Comment Read More »
Blue Shield to update fee schedule effective December 1 Blue Shield recently announced changes to its physician fee schedule that will take effect December 1, 2016. The new rates are now available on the Blue Shield website (under "Helpful Resources," click “Professional Fee Schedule” then click “Search the Claims Fee Schedule”). To view the new fees, change the default date of service on the “Search Fee Schedule” page to December 1, 2016, (effective date of the change) or later. Physicians can also request a copy of the new fees for up to 20 codes by completing the allowance review ... October 13, 2016 General, Managed Care Blue Shield 0 0 Comment Read More »
Physicians encouraged to verify CHPI data by November 11 Earlier this month, approximately 13,000 physicians in California received their individual quality measurement scores for the second cycle of the California Healthcare Performance Initiative System (CHPI) quality rating program. Physicians can review and verify the accuracy of the data used to calculate their scores through the CHPI online portal through November 11, 2016. The program rates physicians using claims data from Medicare fee-for-service, Anthem Blue Cross, Blue Shield of California and United Healthcare. This claims data includes both commercial and self-funded health plan data from HMO, PPO, POS and Medicare ... September 22, 2016 Managed Care, Medicare Medicare, Quality of Care, United Healthcare, Anthem Blue Cross, Blue Shield, CHPI 0 0 Comment Read More »
Blue Shield to shut down for four days in September Last week, Blue Shield of California announced that it would close its doors for the four days after Labor Day to reduce its payroll-related liabilities, citing losses in the Covered California health insurance exchange. The shutdown, lasting from September 5 to 9, will affect most of its 6,000 employees. The company claims this will save it an estimated $4 million. Some Blue Shield customer service representatives and medical services staff are still expected to be on the job during that period. The California Medical Association has also confirmed that while the ... August 25, 2016 Managed Care Blue Shield 0 0 Comment Read More »
Blue Shield implements system fix to correctly pay HPV9 claims Under the Affordable Care Act, health plans are required to provide “first dollar” coverage for preventive services. This means that the plan cannot apply patient cost sharing, such as copays, coinsurance or deductibles, to these services. However, in September 2015, the California Medical Association (CMA) was alerted by a physician practice that Blue Shield of California was applying patient cost sharing when it processed HPV9 claims with CPT code 90651. CMA escalated the issue to Blue Shield and has been working with the payor since then to correct the ... August 9, 2016 Managed Care Affordable Care Act, Blue Shield, ACA 0 0 Comment Read More »
