CMA continues to monitor health plan network directory accuracy Last November, the California Department of Managed Health Care (DMHC) released the results of an audit of the Anthem Blue Cross and Blue Shield Covered California networks. Among other things, the audit found that 12.8 percent of the physicians listed on Anthem’s network were not accepting Covered California patients, while 12.5 percent were not in practice at the location listed in Anthem’s directory. In the case of Blue Shield, only 56.7 percent of the physicians listed in Blue Shield's Covered California directory could be verified as accepting Covered California patients. ... August 17, 2015 Managed Care Blue Shield, Covered California, Network Adequacy, Anthem Blue Cross 0 0 Comment Read More »
Covered California statewide premium costs to rise 4 percent in 2016 Californians insured through Covered California, the state’s health benefit exchange, will see their premiums rise an average of 4 percent in 2016, less than last year’s increase of 4.2 percent. However, consumers in some Bay Area and Sacramento counties will see higher premium increases—up to 8.2 percent in Sacramento and 12.8 percent in Santa Cruz, Monterey and San Benito—while Southern California counties will see increases of around 1.8 percent. However, Covered California Executive Director Peter Lee noted that consumers can see their premiums drop an average of 4.5 percent – ... July 29, 2015 Managed Care Covered California 0 0 Comment Read More »
Anthem Blue Cross begins medical chart reviews in July In July, Anthem Blue Cross will begin chart reviews on enrollees who purchased Affordable Care Act (ACA)-compliant plans in either the individual and small group insurance markets (both on and off the exchange, known as “Covered California”). The records requests are a result of the commercial risk adjustment program created by ACA Section 1343. The primary goal of the risk adjustment program is to spread the financial risk borne by payors more evenly in order to stabilize premiums and provide issuers the ability to offer a variety of plans to ... July 6, 2015 General, Managed Care Affordable Care Act, Anthem Blue Cross, Covered California, ACA, Health Insurance Exchange 0 0 Comment Read More »
Covered California board proposes to cut budget because of slower enrollment Due to tepid enrollment numbers, Covered California’s board of directors has proposed to spend $58 million less in 2016, slashing its marketing and outreach program by 33 percent. Open enrollment in Covered California fell short of its goal of 1.7 million this year, ending with the number of enrollees at 1.4 million. Additionally, the exchange must pay its own way in the future after receiving $1 billion in federal money. And while it still has some $290 million in reserve for 2016, the exchange projects that fewer than 1.5 million ... May 15, 2015 General, Managed Care Covered California, Health Insurance Exchange, Affordable Care Act 0 0 Comment Read More »
Covered California rolls gain 1.4 million people; enrollment extended through end of April Covered California announced that it had 1.4 million people on its rolls and that it had extended the deadline to buy health insurance for people who say they weren't aware they would face a tax penalty. According to Peter Lee, executive director of Covered California, as many as 600,000 California residents face a penalty under the Affordable Care Act for not having insurance. The extension does not exempt people from paying the 2014 tax penalty, but would help them avoid bigger penalties in 2015. On the national front, the White ... February 23, 2015 Managed Care Health Insurance Exchange, Covered California 0 0 Comment Read More »
Be prepared for Covered California changes in 2015 In 2014, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals statewide in new health plans. With Covered California aiming to enroll an additional 500,000 during the 2015 open enrollment period, it is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2015. To help physicians understand the changes taking place and how they will affect their practice, the California Medical Association (CMA) has published a new tip sheet titled, “Surviving Covered California: Preparing for 2015.” December 16, 2014 Managed Care Health Insurance Exchange, Surviving Covered California, Covered California 0 0 Comment Read More »
Physicians encouraged to familiarize themselves with exchange plan changes heading into Covered California open enrollment Covered California began enrollment for its second year on November 15 and exchange officials are predicting a 45 percent jump in enrollment, from 1.2 million in 2014 to 1.7 million in 2015. Last year, open enrollment was a six-month process, this year it will be half as long, starting Nov. 15 and ending Feb. 15. In anticipation of this year's open enrollment, some payors have updated their exchange plan offerings for 2015, including plan types and plan names. The California Medical Association (CMA) will be publishing details of these changes ... November 17, 2014 Managed Care Affordable Care Act, Health Insurance Exchange, ACA, Covered California 0 0 Comment Read More »
Blue Shield announces changes to 2015 exchange/mirror products On October 1, 2014, Blue Shield of California notified participating physicians that it was making changes to its Individual and Family Plan (IFP) EPO and PPO products, which are its exchange/mirror products. According to Blue Shield, the changes aim to expand access for EPO enrollees and reduce confusion by simplifying its plan names. Effective January 1, 2015, Blue Shield exchange/mirror EPO patients will have access to additional providers who are located outside of their county of residence. Previously, the Blue Shield IFP EPO limited in-network services to providers within ... November 14, 2014 Managed Care Covered California, Exchange Plans, Health Insurance Exchange, Blue Shield 0 0 Comment Read More »
Health Net modifying exchange/mirror products Health Net recently announced changes to its exchange/mirror products offered for 2015. In a notice mailed to select physicians, the insurer said it will be offering an Exclusive Provider Organization (EPO) and a Health Care Service Plan (HSP) for its individual exchange/mirror products effective January 1, 2015. Though not explicitly stated in the notice, the California Medical Association (CMA) has confirmed the insurer will not be offering a PPO product in the individual exchange/mirror market. The EPO will be called PureCare One and the HSP will be called PureCare. Patients will ... November 5, 2014 Managed Care Health Insurance Exchange, Health Net, Covered California 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 »
