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Health Net Federal Services experiences significant challenges with TRICARE transition

On January 1, 2018, Health Net Federal Services (HNFS) became the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region, serving approximately 2.9 million beneficiaries in 21 western states, including California. HNFS took over the contract previously held by UnitedHealthcare Military and Veterans’ Services (UMVS). The California Medical Association (CMA) has learned that HNFS has experienced implementation issues related to provider contracting and credentialing, beneficiary reassignment to new primary care managers (PCM), and provider directory inaccuracies. The contracting and credentialing issues in California are reportedly related ...

CMA updates MACRA preparation checklist

The California Medical Association’s (CMA) Center for Economic Services has published an update to its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) preparation checklist. The checklist, “MACRA: What Should I Do Now to Prepare?”, is available in CMA's MACRA resource center at www.cmanet.org/macra.  CMA published this important checklist to help physicians understand MACRA payment reforms and what they can do now to start preparing for the transition. Also available in the MACRA resource center is an overview of MACRA, and a comprehensive list of tools, resources and information ...

Verifying your patients' eligibility and benefits in 2015 may save your practice thousands of dollars

With the new year soon upon us, physicians are urged to be diligent in verifying patients' eligibility and benefits to ensure that you will be paid for services rendered. The beginning of a new year means calendar year deductibles and visit frequency limitations start over. With open enrollment there may also be changes to patients’ benefit plans, or they may even be insured through a new payor. The new year also brings a host of other challenges that could affect your ability to be paid: Medicare patients ...

Updated payor profiles now available

The California Medical Association’s (CMA) Center for Economic Services has published updated profiles on each of the major payors in California including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net, United Healthcare, Medicare/Noridian and Medi-Cal. Each profile includes key information on health plan market penetration, a description of the plan’s dispute resolution process and the name and contact numbers for medical directors, provider relations and other key contacts. Don’t waste your time searching the internet for this information – members can download CMA’s Payor Profiles free ...

What does the ICD-10 delay mean for physicians?

The ICD-10 compliance date will be delayed by at least one year, based on a provision in a federal law signed Tuesday that pushes the date to no sooner than October 1, 2015. It is unclear at this time how this unexpected delay will impact the health care industry, which has been feverishly working to prepare for the transition to the new code sets, previously scheduled for October 1, 2014.   The International Classification of Disease tenth revision (ICD-10) is a system of coding created in 1992 as the successor to ...

Medi-Cal offers billing seminars April 22 and 23 in Anaheim

Throughout the year, the Department of Health Care Services (DHCS) offers in person Medi-Cal training seminars, designed for providers and billing staff at all levels. The next two seminars are scheduled for April 22 and 23, 2014, at the Anaheim Convention Center.   These seminars cover the following topics: Changes to Medi-Cal billing ICD-10 overview Basic and advanced billing issues Provider-specific billing questions Specialty programs such as California Children’s Services/Genetically Handicapped Persons Program For more information or ...

Practices required to use new CMS 1500 claim form beginning April 1

Earlier this year, the White House Office of Management and Budget (OMB) approved the revised Centers for Medicare & Medicaid Services (CMS) 1500 claim form (version 02/12 OMB control number 0938-1197). The CMS 1500 claim form is the required format for submitting paper claims to Medicare. As of April 1, 2014, CMS will no longer accept paper claims on the old form. Until then, CMS is accepting both the old and new forms.   The revised form adds the following functionality: Indicators for differentiating between ICD-9 and ICD-10 ...

CMS launches new online ICD-10 implementation guide

The Centers for Medicare & Medicaid Services (CMS) recently launched an online ICD-10 implementation guide to help practices of all sizes successfully make the switch to the new ICD-10 coding system, which is used to report medical diagnoses and inpatient procedures. Physicians and payors must begin using the new code sets by October 1, 2014.   ICD-10 (The International Classification of Disease tenth revision) is a system of coding created in 1992 as the successor to the previous ICD-9 system. ICD-10 will include new procedures and diagnoses, which the U.S. Department ...

AMA's new "administrative burden index" ranks cost of doing business with commercial insurers

The American Medical Association (AMA) recently unveiled its new Administrative Burden Index (ABI), which ranks commercial health insurers according to the level of unnecessary cost they contribute to the billing and payment of medical claims. The ABI reflects the overhead cost needed to bill and collect payment from each major payer and was introduced as part of AMA's annual National Health Insurer Report Card. AMA found that administrative tasks associated with avoidable errors, inefficiency and waste in the medical claims process resulted in an average ABI cost per claim of ...