CMA applauds U.S. Justice Department lawsuit against health insurance mega-mergers The California Medical Association (CMA) today applauded the U.S. Department of Justice (DOJ) for filing two lawsuits challenging the proposed merger of Anthem and Cigna and of Aetna and Humana — all of which are among the largest health insurance companies in the country. “We applaud the DOJ for protecting patients against mega-mergers that would drastically reduce competition in the health insurance market, leaving patients at a huge disadvantage in the pursuit of timely and affordable health care,” said CMA President Steven Larson, M.D., MPH. “We also commend California Insurance ... August 5, 2016 Managed Care Aetna, Anthem Blue Cross, Cigna, Department of Justice, DOJ, Advocacy, Humana 0 0 Comment Read More »
DOJ files lawsuit to block two health insurance mega-mergers The U.S. Department of Justice (DOJ) today filed two lawsuits to block health insurance mega-mergers that would compromise patients’ access to care, and negatively impact the quality and affordability of health care across the country. “If allowed to proceed, these mergers would fundamentally reshape the health insurance industry,” U.S. Attorney General Loretta Lynch said at a press conference. “They would leave much of the multi-trillion dollar health insurance industry in the hands of three mammoth insurance companies, restricting competition in key markets.” The California Medical Association (CMA) has long-held concerns over ... August 5, 2016 Managed Care Cigna, Department of Justice, DOJ, Aetna, Anthem Ble Cross, Humana 0 0 Comment Read More »
DMHC IMR/complaint webinar now available on-demand The California Department of Managed Health Care (DMHC), the regulatory agency that oversees 122 health plans, recently conducted a webinar for the California Medical Association (CMA) to provide an overview of the department with a focus on the DMHC Help Center and its Independent Medical Review (IMR) process. DMHC Deputy Director of Health Policy and Stakeholder Relations Mary Watanabe provided an overview of the department’s IMR and complaint processes, including the importance of these processes in the policy, legislative and regulatory arenas. Also provided was information on how to ... July 14, 2016 Managed Care DMHC, Webinars, Department of Managed Health Care 0 0 Comment Read More »
Updated payor profiles available The California Medical Association’s (CMA) Center for Economic Services has published updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, United Healthcare, 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 ... July 14, 2016 Managed Care Payors, Payor Profiles 0 0 Comment Read More »
CMA publishes guide on new provider directory accuracy law On July 1, 2016, a new law took effect that requires plans to ensure that their physician directories are accurate and up-to-date. The law (SB 137) includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payors' networks. The California Medical Association (CMA) has published a new guide to help physicians understand the new law, and what they need to do to avoid penalties. The guide, "What Physicians Need to Know to Avoid Penalties Under the New Provider Directory Accuracy ... July 14, 2016 General, Managed Care Provider Directory Accuracy Law, Provider Directories 0 0 Comment Read More »
Have you gotten an information request from BetterDoctor? The California Medical Association (CMA) has received several inquiries over the past few weeks from practices concerned about the validity of requests for information from a company called BetterDoctor. As you may know, a new law took effect July 1 that requires payors to ensure that their physician directories are accurate and up-to-date. BetterDoctor is a vendor working on behalf of a number of plans on a pilot project to ensure the accuracy of their physician directories as required under the new law. Practices are encouraged to respond to the ... July 14, 2016 Managed Care Provider Directories, Provider Directory Accuracy Law 0 0 Comment Read More »
Physicians advised to check enrollment status of pregnant patients insured by Covered California In April, news broke that nearly 2,000 pregnant women with Covered California health plans were automatically – and without their knowledge or consent – transferred from their exchange plan to Medi-Cal, even though they were supposed to have the option to stay with Covered California. The problem, attributed by Covered California partly to a computer glitch, can be traced to a recent policy change. Usually, consumers are placed in either Covered California or Medi-Cal based on their income, with no choice in the matter. But the rules are different for some ... June 8, 2016 Managed Care, Medi-Cal Covered California, Medi-Cal, Women's Health 0 0 Comment Read More »
DHCS suspends planned passive enrollment for duals project The Department of Health Care Services (DHCS) announced last week that it would not move forward with its planned annual passive enrollment of dual eligible beneficiaries under the Coordinated Care Initiative (CCI) after it received feedback from the California Medical Association (CMA) and 40 other stakeholders asking the agency to pursue enrollment strategies that support voluntary "opt-in" enrollment. Instead, DHCS said it will implement a voluntary "opt-in" enrollment effort beginning in July 2016. The new streamlined enrollment strategy will include mandatory Managed Medi-Cal Long-Term Supports and Services (MLTSS) plan enrollment. ... June 8, 2016 Managed Care, Medi-Cal, Medicare Medi-Cal, Medicare, Cal-MediConnect, Department of Health Care Services, Dual Eligible 0 0 Comment Read More »
Anthem software upgrade caused widespread claims payment errors in March Anthem Blue Cross recently announced that a software upgrade the weekend of March 19 resulted in a zero allowance for some provider claims. According to Anthem, approximately 130,000 claims were affected. The error was resolved on Thursday, March 24. The California Medical Association (CMA) was made aware of this problem by calls from members to our reimbursement help line. Anthem advised CMA that all impacted claims will automatically be reprocessed within 90-120 days and physicians do not need to resubmit claims or file appeals. Interest and penalties will automatically be ... April 18, 2016 Managed Care Commercial Insurance, Anthem Blue Cross 0 0 Comment Read More »
Open Payments review and dispute period now open Drug and medical device manufacturers have completed their submission of data to the Open Payments system on payments or transfers of value made to physicians and teaching hospitals during 2015. Physicians and teaching hospitals now have 45 days to review and dispute records attributed to them. The review and dispute period is open from April 1 until May 15, 2016. The review and dispute process is voluntary, but encouraged. The Centers for Medicare and Medicaid Services (CMS) will publish the 2015 payment data and updates to the 2013 and 2014 ... April 4, 2016 General, Managed Care, Medi-Cal, Medicare CMS, Physician Payments Sunshine Act, Centers for Medicare and Medicaid Services 0 0 Comment Read More »
