Surviving the first month of Covered California On January 1, 2014, California's health benefit exchange, Covered California, began providing health coverage to more 400,000 patients statewide. 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 that end, the California Medical Association (CMA) offers these tips to survive the first month of Covered California. This document is available to members only. Please join CMA or Login to access the document. January 9, 2014 Managed Care Health Insurance Exchange, Covered California, Health Benefit Exchange, Health Care Reform 0 0 Comment Read More »
Duals demonstration project delayed in three counties The California Department of Health Care Services (DHCS) has delayed passive enrollment for three of the eight counties affected by the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The project in these three counties—Alameda, Santa Clara and Los Angeles—will begin instead with a voluntary period, during which patients can choose early enrollment with a Medi-Cal managed care plan, or wait until the automatic passive enrollment period, which will begin no earlier than July 1, 2014. The project—known as Cal MediConnect—was authorized by the state in July 2012 ... December 16, 2013 Managed Care Dual Eligible, Insurance/Reimbursement, Medicare, Medi-Cal 0 0 Comment Read More »
Blue Shield announces fee schedule changes effective December 1 Blue Shield announced changes to its physician fee schedule that will take effect December 1, 2013. In a September 23 notice to physicians, the insurer said that it would be increasing payment for evaluation and management services for preventive care. Additionally, Blue Shield notes payment increases for the more commonly billed office visit codes 99204, 99205, 99213 and 99214. The new rates will be available on the Blue Shield website (under Helpful Resources) beginning October 1. Physicians can also request a copy of the new fees by completing the allowance ... October 2, 2013 Managed Care Blue Shield, Managed Care, Payor Contracting, Insurance/Reimbursement 0 0 Comment Read More »
State delays duals pilot project until April 1 The California Department of Health Care Services (DHCS) announced today that it would delay by three months implementation of the state's "pilot project" to redesign care for Medicare/Medi-Cal dual eligibles. The program, called CalMediConnect, is now expected to begin no earlier than April 2014. The project was authorized by the Assembly in July 2012 in an effort to save money and better coordinate care for the state’s low-income seniors and persons with disabilities. The program begins with a three-year demonstration project that would see a large portion of the state's ... August 15, 2013 Managed Care, Medi-Cal, Medicare DHCS, Medi-Cal, Medicare, Dual Eligible, Insurance/Reimbursement 0 0 Comment Read More »
Anthem Blue Cross announces changes to reimbursement policies and claims software In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer’s reimbursement policies and claims editing software called ClaimsXten. The changes will go into effect on November 1, 2013. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. Changes include: denial of 3D rendering CPT codes 76376 ... August 7, 2013 Managed Care Insurance/Reimbursement, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
CMA Launches Exchange Resource Center In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the individual and small group health insurance markets and, beginning in 2014, will provide health insurance to much of the nation's uninsured. Under the ACA, two-thirds of California's uninsured may be eligible to purchase coverage through the health benefit exchange. The exchange's goal is to begin open enrollment on October 1, 2013 – with coverage beginning on January 1, 2014. To help educate physicians about the exchange and ensure that they are ... July 16, 2013 General, Managed Care Covered California, health insurance exchange, Affordable Care Act (ACA) 0 0 Comment Read More »
Next phase of Healthy Families to Medi-Cal transition scheduled for August 1 Phase 3 of the Healthy Families transition from fee-for-service to Medi-Cal managed care is scheduled for August 1, 2013. This phase will impact approximately 107,000 children who have a Healthy Families plan that does not offer Medi-Cal managed care or subcontract with a Medi-Cal managed care plan, thus requiring them to transition to a new plan. This is the first phase of the Healthy Families transition where patients may be required to change physicians. Enrollment will include consideration of the child’s primary care providers. Affected counties are: ... July 9, 2013 Managed Care, Medi-Cal Managed Care, Medi-Cal, Healthy Families 0 0 Comment Read More »
Physicians are encouraged to check Covered California's provider database in July As previously reported, there remain some uncertainties around the process of physician contracting with exchange plans. Beginning sometime in July, the exchange should alleviate much of the uncertainty as to who is and is not considered to be an exchange provider. This is because Covered California will be unveiling a centralized online provider database for the first time in July. Using this database, exchange patients will be able to see which providers are included in the respective exchange plans’ networks. This centralized database will also be utilized by the exchange’s eligibility ... July 8, 2013 Managed Care Health Care Reform, Health Insurance Exchange, Affordable Care Act, Covered California 0 0 Comment Read More »
ACA: Medicaid Primary Care Rate Increase FAQ Under the provisions of the Federal Affordable Care Act (ACA), state Medicaid programs (Medi-Cal in California) are required to pay primary care physicians at Medicare rates for primary care services for two years. The increase is fully funded by the federal government. The requirement began January 1, 2013 and ends December 31, 2014. The California Department of Health Care Services (DHCS) submitted their state plan amendment (SPA) to implement the rate increase on March 29, 2013. Approval of the SPA is required by the Centers for Medicare and Medicaid Services ... April 19, 2013 Managed Care, Medi-Cal, Medicare ACA, Affordable Care Act, Medicare, Medi-Cal 0 0 Comment Read More »
TRICARE Transition Guide On April 1, 2013, United Health Military & Veterans Services (UMVS) began providing managed care services to 2.9 million TRICARE beneficiaries in the 21 western states, including California. On that date, UMVS took over the contract previously held by TriWest. To help physicians understand the impact the transition will have on their practices, CMA has prepared a TRICARE Transition Guide. (members only; login required) April 2, 2013 General, Managed Care Managed Care Services, UMVS, TRICARE, United Health Military and Veterans Services 0 0 Comment Read More »
