United to make some changes to Premium Designation program, but serious concerns remain United Healthcare (UHC) has agreed, at the urging of the California Medical Association (CMA), to make some changes to its Premium Designation program. However, UHC refused to address many critical problems that CMA had identified, and CMA still believes the program continues to have serious shortcomings. CMA continues to urge UHC to make additional, more meaningful changes with its physician rating and tiering program. "In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them ... September 4, 2014 Managed Care Managed Care, Insurance/Reimbursement, United Healthcare 0 0 Comment Read More »
CMA urges United to make meaningful changes to Premium Designation program Citing physician confusion and complaints as well as additional concerns with the rollout of the United Healthcare (UHC) Premium Designation program, the California Medical Association (CMA) has, again, urged the insurer to make meaningful and necessary changes to the program prior to the next assessment this fall. "In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them in making important health care decisions,” wrote CMA President Richard Thorp, M.D., in an August 13, 2014, ... August 21, 2014 Managed Care Managed Care, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
Anthem Blue Cross begins medical chart reviews for exchange patients In July, Anthem Blue Cross began chart reviews on enrollees who purchased an individual exchange or mirror product. Similar to the Medicare Risk Adjustment Audit process, and as required by the Affordable Care Act (ACA), the audit is designed to identify the health status and demographic characteristics of exchange/mirror product enrollees. Blue Cross will review diagnosis code data obtained from the medical records of exchange patients. This is not a typical audit on the physician practice; rather, Blue Cross is looking to identify conditions/illnesses that demonstrate patients who are at ... August 7, 2014 Managed Care Anthem Blue Cross, Covered California, Health Insurance Exchange, Health Care Reform 0 0 Comment Read More »
Blue Shield mailer to physicians on exchange On July 11, 2014, Blue Shield mailed additional informational packets to physicians contracted for its exchange/mirror products. Blue Shield also sent separate packets to the corresponding office managers for which they had contact information. While Blue Shield has sent out several communications to contracting exchange providers, the plan reports this informational packet was developed based on feedback from practice staff and includes sample ID cards for Covered California and mirror products, a product guide, laminated map indicating which products are offered in each county, and step-by-step instructions on how to ... August 7, 2014 Managed Care Covered California, Health Insurance Exchange, Blue Shield 0 0 Comment Read More »
United Healthcare finally completes PacifiCare recontracting effort after 2006 merger The California Medical Association (CMA) recently learned that United Healthcare (UHC) in April sent notices to over 800 practices that still held contracts under PacifiCare, which merged with UHC in 2006. The notice advised affected physicians that their continued participation status with UHC hinged on signing the new agreement, which includes a new fee schedule. For physicians who chose not to sign the agreement by June 15, the notification served as the required 90-day notice of termination. UHC had first initiated a recontracting of physicians contracted with PacifiCare back in ... August 7, 2014 Managed Care Hunited Healthcare, Insurance/Reimbursement, Managed Care, PacifiCare, Advocacy 0 0 Comment Read More »
Despite CMA concerns, United moves forward with Premium Designation program Sidestepping concerns voiced by the California Medical Association (CMA), United Healthcare is proceeding with the rollout of its "Premium Designation" physician performance program in California. Physicians who wish to request a reconsideration of their Premium Designation status before the results are displayed publicly in the insurers’ network directory on August 6, must do so no later than July 16. CMA had urged United Healthcare to delay implementation for a minimum of six months to allow time for the insurer to address deficiencies with the program and to allow physicians the ... July 1, 2014 Managed Care Managed Care, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
Three major exchange plans provide guidance for physicians Three major managed care payors offering coverage through Covered California have provided additional information to their contracted providers on their exchange/mirror products. Together, these three payors – Health Net, Anthem Blue Cross and Blue Shield of California – account for approximately 75 percent of enrollment in Covered California products to date. The notices, sent to physicians within the past few weeks, were cobranded with Covered California and contain additional information to help providers navigate the exchange. The Health Net notice, sent on March 7, includes information such as the exchange/mirror products ... March 20, 2014 Managed Care Blue Shield, Covered California, Health Insurance Exchange, Health Net, Anthem Blue Cross 0 0 Comment Read More »
Surviving the third month of Covered California As of February 15, Covered California reports that more than 828,000 individuals have enrolled in exchange plans, which surpasses its original target. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect. To help answer some of the more common questions, the California Medical Association (CMA) offers this third tip sheet to help physicians survive the third month of Covered California. Also see "Surviving the First Month of Covered California" and "Surviving the ... March 7, 2014 Managed Care Health Insurance Exchange, Practice Resources, Covered California 0 0 Comment Read More »
Covered California removes provider directory, again Following numerous complaints from both enrollees and providers, Covered California has removed its provider directory from the exchange website until further notice. "While the combined provider directory was a useful service for many consumers, some enrollees located physicians thought to be in their plan, and subsequently discovered they were not,” exchange staff wrote in a statement, noting that enrollees who relied upon information present in the provider directory should contact their health insurance plan to verify the provider is in the exchange network. CMA is also encouraging patients to contact ... February 12, 2014 Managed Care Covered California 0 0 Comment Read More »
Blue Shield exchange/off-exchange plans leading to confusion among physicians The California Medical Association (CMA) has seen a large increase in calls from physicians confused about the plans/products offered by Blue Shield both on and off the exchange. As you may know, federal law requires that every plan offered in the exchange also be offered off the exchange, using the same network. This has resulted in a number of practices unknowingly seeing patients out-of-network for products that use the insurer's narrower exchange network. It has also created an additional level of confusion for physician practices when checking patients' coverage ... February 12, 2014 Managed Care Covered California, Health Benefit Exchange, Health Insurance Exchange, Insurance/Reimbursement, Managed Care, Blue Shield 0 0 Comment Read More »
