Blue Shield implements system fix for AB 72 claims Last year, the California Medical Association (CMA) worked with Blue Shield of California to correct two issues affecting accurate payment of claims subject to the state’s new out-of-network billing and payment law (AB 72). The issues were identified as being due to manual claim processing errors, because the payor had not yet updated its system to allow automated processing of claims subject to AB 72. Blue Shield recently announced it was implementing a system update on June 28, 2018, that will allow claims subject to AB 72 to be processed ... July 11, 2018 General, Managed Care AB 72, Blue Shield, Out of Network Care 0 0 Comment Read More »
Payors report system changes to comply with AB 72 When California’s new out-of-network billing and payment law (AB 72) took effect on July 1, 2017, the California Medical Association (CMA) began receiving calls from physician offices concerned that Anthem Blue Cross and Blue Shield of California were not correctly paying claims. In both cases the incorrect payments were linked to manual processing of AB 72 claims. CMA worked with Blue Shield to ensure affected claims through October of 2017 were automatically reprocessed. Blue Shield also committed to conducting weekly audits to catch any additional claims that were processed erroneously. ... April 5, 2018 General, Managed Care Anthem Blue Cross, Blue Shield, Economic Advocacy, AB 72, Out of Network Care 0 0 Comment Read More »
Are you being paid correctly under California's new out-of-network billing and payment law? Effective July 1, 2017, California’s new out-of-network billing and payment law (AB 72) requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. The interim rate is the greater of the payor’s average contracted rate or 125 percent of the amount that Medicare reimburses on a fee-for-service basis for the same or similar services in that geographic region. This law ... January 29, 2018 CMA, General Economic Advocacy, AB 72, Medical Provider Networks, Out of Network Care, Provider Networks 0 0 Comment Read More »
Anthem still not complying with AB 72 interim payment rules, physicians report The California Medical Association (CMA) has continued to receive reports from physician offices that Anthem Blue Cross is not paying the “interim payment” as required under California’s new law (AB 72) limiting out-of-network billing for covered, non-emergent services performed at in-network facilities. CMA has also received reports that Anthem representatives have advised some physicians that its Covered California EPO products are not subject to AB 72, which is incorrect. The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for non-emergent services performed ... December 28, 2017 Managed Care Anthem Blue Cross, AB 72, Economic Advocacy, Out of Network Care 0 0 Comment Read More »
CMA publishes AB 72 payment monitoring workbook The California Medical Association has published a workbook to help practices identify if payments they receive comply with AB 72's interim payment rules. AB 72—California’s new out-of-network billing and payment law—requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. The interim rate defined in AB 72 is the greater of the average contracted rate (including only commercial contracts) or 125 ... October 19, 2017 CMA AB 72, Billing/Coding/Out of Network Care 0 0 Comment Read More »
CMA guide helps physicians challenge AB 72 interim payments The California Medical Association (CMA) has published a new guide to help physicians challenge “interim payments” under the new AB 72 out-of-network billing and payment law. The guide is free and available exclusively to members in CMA’s AB 72 resource center at www.cmanet.org/ab-72. On July 1, 2017, the new law (AB 72) took effect changing the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law requires plans and insurers to reimburse physicians at the greater of either the payor’s ... October 13, 2017 General, Managed Care AB 72, Economic Advocacy, Out of Network Care 0 0 Comment Read More »
Webinar: How to challenge the AB 72 interim payment for out-of-network services On July 1, 2017, a new law (AB 72) took effect that changes the billing practices of non-participating physicians providing covered, non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law was designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. Under the new law, plans/insurers are required to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities. The interim payment is the greater of either the plan/insurer’s average ... September 25, 2017 General, Managed Care AB 72, Out of Network Care, Webinars 0 0 Comment Read More »
Physicians report Anthem not complying with AB 72 interim payment rules The California Medical Association (CMA) has received reports from physician offices that Anthem Blue Cross is not paying the “interim payment” as required under the recently effective law (AB 72) limiting out-of-network billing for covered, non-emergent services performed at an in-network facility. The new law requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. The interim rate defined in AB 72 ... September 25, 2017 General, Managed Care AB 72, Anthem Blue Cross, Out of Network Care 0 0 Comment Read More »
CDI issues instructions for "average contracted rate" under new out-of-network billing and payment law On July 1, 2017, a new law (AB 72, 2016) will take effect that changes the billing practices of non-contracted physicians providing non-emergent care at in-network facilities including hospitals, ambulatory surgery centers and laboratories. The law is designed to reduce unexpected medical bills when patients go to an in-network facility but receive care from an out-of-network doctor. While patients with out-of-network benefits can consent to treatment from out-of-network providers, absent a valid consent form, health plans and insurers are required to reimburse out-of-network physicians at an interim payment rate. The ... June 22, 2017 Managed Care Out of Network Care, AB 72 0 0 Comment Read More »
