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 »
Error on Anthem ID cards results in claim denials In late March, the California Medical Association (CMA) began receiving complaints from physicians in San Diego, Orange and Bay Area counties about denials from Anthem Blue Cross. Practices reported that patients presented to their offices with Anthem ID cards that indicated they had a Covered California/mirror PPO product and subsequent eligibility verification also indicated the patient had a PPO product. However, Anthem later denied the claims stating the services were not covered under the patients' benefit plans because they received services from out-of-network providers. CMA escalated the issue to Anthem and ... July 1, 2014 General Covered California, Health Insurance Exchange, Anthem Blue Cross 0 0 Comment Read More »
Provider access issues plague Anthem and Blue Shield as DMHC begins investigation The Department of Managed Health Care (DMHC) recently began conducting a "non-routine audit" of Anthem Blue Cross and Blue Shield of California to investigate the accuracy of the plans' provider directories and identify whether either plan violated any network adequacy laws. According to the DMHC, consumer complaints about access issues for both plans prompted the investigation. Blue Cross and Blue Shield are the only two exchange plans using narrowed provider networks for their exchange and "mirror" products. The state is looking at whether the networks are too narrow in some ... July 1, 2014 General Department of Managed Health Care, Covered California, Payor Contracting 0 0 Comment Read More »
Anthem mistakenly lists almost 1,000 physicians as participating in individual/exchange network Anthem Blue Cross recently notified 965 physicians that they were erroneously listed as participating in the payor’s individual/exchange network. The April 9 notice states that affected physicians were “inadvertently” listed for “a certain period of time” during open enrollment. After receiving a number of complaints from physicians who believed they were listed inaccurately as participating in the Anthem Blue Cross individual/exchange network provider directory, the California Medical Association (CMA) contacted Anthem to discuss the matter. At that time, Anthem acknowledged the error and said that affected patients had already been ... April 16, 2014 General Covered California, Health Insurance Exchange, Anthem Blue Cross 0 0 Comment Read More »
Anthem accidentally overpays some physicians Anthem Blue Cross recently notified almost 8,500 practices of a claims pricing error that caused some physicians to be paid for services provided to individual/exchange patients at Anthem's higher Prudent Buyer PPO rates. In the April 9 notice to physicians, Anthem states it had been applying “discounted rates inconsistently” on claims for dates of service January 1 through March 31, 2014. According to the payor, the error was corrected effective for dates of service on or after April 1, 2014. While not mentioned in the notice, Anthem has advised the California ... April 16, 2014 General Covered California, Health Insurance Exchange, Anthem Blue Cross 0 0 Comment Read More »
Anthem Blue Cross to host webinars on its exchange products Anthem Blue Cross is inviting physicians to attend a series of special one-hour presentations about their products being offered under Covered California, the state's health benefit exchange. The webinars will be offered in late April and how to confirm participation status, overview of their exchange/mirror product provider networks, plan names, enrollment periods, covered benefits, sample ID cards, risk adjustment and provider resources. Dates and times for the webinars are Tuesday, April 22, from 2-3 p.m., and Tuesday, April 29, from 2-3 p.m. Participants do not need to register to attend, but ... April 4, 2014 General Webinars, Anthem Blue Cross, Covered California, Health Insurance Exchange 0 0 Comment Read More »
Blue Cross experiencing problems with electronic eligibility and benefits information The California Medical Association (CMA) has received several reports of physician offices being unable to electronically verify eligibility and benefits for Anthem Blue Cross patients. When attempting such verification, the Anthem system returned a message asking the practice to call to obtain the information. However, practices report significant hold times of one hour or more when calling for this information. Anthem has acknowledged a system problem affected the ability of practices to electronically verify eligibility and benefits information for patients with coverage issued on or after January 1, 2014, which ... March 27, 2014 General Covered California, Health Insurance Exchange, Anthem Blue Cross 0 0 Comment Read More »
Covered California patients have until March 31 to switch plans Covered California patients have until March 31 to switch exchange plans if they made selections based on an inaccurate provider directory. On February 7, following numerous complaints about accuracy from both enrollees and providers, Covered California removed its provider directory from the exchange website. However, some patients had already selected plans based on inaccurate provider directory information. CMA has received multiple inquiries from practices asking whether these patients have any options. The answer is yes. Patients can contact the Covered California’s Service Center at (800) 300-1506 to switch to a ... March 27, 2014 General Health Insurance Exchange, Covered California 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 »
