DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019 The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Medi-Cal fee-for-service physician payments for the 2018-2019 fiscal year. The supplemental payments—made possible by the Proposition 56 tobacco tax funding—will raise payments for a total of 23 CPT codes, including 10 new preventive CPT codes. DHCS will be increasing the supplemental payment for the previously eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017 – 2018 payment levels). The 10 ... September 21, 2018 Managed Care, Medi-Cal Advocacy, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Have you received your supplemental Medi-Cal managed care payments? The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. While the California Department of Health Care Services (DHCS) began disbursing FY 2017-2018 supplemental fee-for-service payments in January 2018, federal approval of the supplemental Medi-Cal managed care payments was delayed. This resulted in delayed payment for Medi-Cal managed care services. DHCS began dispersing the FY 2017-2018 funds to the plans ... September 21, 2018 Managed Care, Medi-Cal Advocacy, Medi-Cal, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
Health Net addresses problems with explanation of payment On August 21, 2018, Health Net notified providers that some paper explanation of payment (EOPs), commonly known as explanations of benefits, for commercial exchange enrollees were not displaying amounts correctly. This problem prevented providers from properly reconciling the amount Health Net is responsible for or the patient cost-sharing. Health Net reports it has resolved all issues related to the misprinted EOPs, except in instances where the enrollee’s cost share may not be correctly displaying a figure that includes any coinsurance amount. Health Net advises that a fix for the cost ... September 12, 2018 Managed Care Commercial Payors, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
UnitedHealthcare to discontinue use of fax numbers for medical prior authorization requests UnitedHealthcare announced in its September 2018 Network Bulletin that it will begin retiring fax numbers utilized for medical prior authorization requests beginning January 1, 2019. Providers will be directed to utilize the Prior Authorization and Notification tool on Link, the UHC website currently utilized to check eligibility and benefits, manage claims and update provider demographic information. The following fax numbers will be retiring as of January 1, 2019: (877) 269-1045 (866) 362-6101 (866) 892-4582 (866) 589-4848 ... September 12, 2018 Managed Care Commercial Payors, Practice Management 0 0 Comment Read More »
Health Net Federal Services continues to address TRICARE transition issues As previously reported, Health Net Federal Services (HNFS) has experienced implementation issues since taking over as the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region on January 1. In recent discussions with the California Medical Association (CMA), HNFS said it continues to address the breakdowns in process and resulting consequences that have impacted TRICARE providers in the areas of provider contracting and credentialing, beneficiary reassignment and provider directory inaccuracies. Updates are as follows: Contracting and Credentialing Because of staffing and operational issues, physicians may have experienced ... September 12, 2018 Managed Care Commercial Payors, Payor Contracting, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
UnitedHealthcare Community Plan preps for entry into additional Medi-Cal and Medicare Advantage markets Looking to potentially enhance its footprint in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California has issued unilateral contract amendments to contracted physicians in seven California counties. Additionally, UHC providers in the seven counties who are not currently contracted for the Medicare Advantage product will receive a combined contract amendment for participation in both UHC Community Plan of California (Medi-Cal) and UHC Medicare Advantage products. As a condition of participation in the Medi-Cal Managed Care request for proposal process in late 2019 or early 2020, ... August 23, 2018 Managed Care, Medi-Cal, Medicare Commercial Payors, Payor Contracting, Public Payors 0 0 Comment Read More »
United Healthcare releases latest Premium Designation physician results United Healthcare (UHC) recently released its latest Premium Designation assessment results to California physicians on July 20. The Premium Program Version 11 results, based on claims data from January 1, 2015, through February 28, 2018, will be released publicly via the payor's online physician directory beginning September 2018. Physicians within 16 specialty categories, encompassing 47 subspecialties including pediatric internal medicine (new for 2018), will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. Physicians meeting or exceeding these benchmarks will receive a ... August 3, 2018 Managed Care Commercial Payors, Practice Management 0 0 Comment Read More »
United Healthcare Smart Edits go live August 16 UnitedHealthcare (UHC) will implement its Smart Edits program for professional claims for all of its commercial, Medicare Advantage and Community Plans effective August 16, 2018. UHC notified physicians in its 2018 United Healthcare network bulletin that it would implement Smart Edits, a new functionality introduced into the electronic data interchange (EDI) workflow allowing the payor to autodetect claims with potential errors in the claims pre-adjudication phase. Once a potential error has been identified, UHC will notify the physician (via the 277CA report) within 24 hours, returning the claim to ... August 3, 2018 General, Managed Care Commercial Payors, Payor Issues and Reimbursement, Practice Management 0 0 Comment Read More »
CMA joins California Department of Insurance in opposing CVS/Aetna Merger Today, the California Medical Association (CMA) applauded the finding of the California Department of Insurance that the proposed merger between CVS Health and Aetna, Inc. would significantly reduce competition in California’s health insurance market and calls on the U.S. Department of Justice to block the merger from proceeding. In a letter submitted to the U.S. Attorney General and Assistant Attorney General for the Antitrust Division, Insurance Commissioner Dave Jones concluded that the proposed merger would create anti-competitive conditions in the Medicare Part D market, the Pharmacy Benefit Manager services market ... August 2, 2018 General, Managed Care Advocacy, Commercial Payors, Payor Issues and Reimbursement 0 0 Comment Read More »
Blue Shield CEO addresses California physicians on digital health efforts Paul Markovich, president and CEO of Blue Shield California, on Friday addressed the California Medical Association’s (CMA) Board of Trustees, to discuss the payor’s initiatives to develop new health care technologies including sharable digital patient records and electronic claims among other initiatives. Markovich told the CMA trustees that Blue Shield was seeking to reduce administrative costs significantly over the next three years to help support investment in numerous digital efforts. Blue Shield and CMA announced in June a new, multi-year collaboration to develop and support a new health care model that ... July 26, 2018 CMA, General, Managed Care Health Information Technology, Physician Leadership 0 0 Comment Read More »
