Health plans terminate contracts with EHS and transition patients to other entities As previously reported, the California Department of Managed Health Care (DMHC) issued a cease-and-desist order on December 26, 2017, requiring nine health plans to terminate their contracts with Employee Health Systems (EHS) Medical Group Inc. This order comes after SynerMed—a company closely affiliated with EHS—was accused of blocking patient access to specialists to hold down costs. EHS has 600,000 patients statewide—90 percent of whom are Medi-Cal managed care patients. As required by DMHC, health plans affected by this order were required to submit a transition plan by January 3, 2018, ... February 5, 2018 Managed Care, Medi-Cal Continuity of Care, Department of Managed Health Care, DMHC, Health Plans, Insurance, Medi-Cal, Payor Contracting 0 0 Comment Read More »
Health plan group pilots program to improve physician directories America's Health Insurance Plans (AHIP) is launching a pilot program to ensure that physician directories are more accurate and up-to-date, the organization announced last week. The pilot program involves two directory vendors, BetterDoctor and Availity, and will include providers in three states: California, Florida and Indiana. The pilot program will run from April to September, according to AHIP, and will include the following eight California plans: Anthem Blue Cross Blue Shield of California Health Net of California Humana ... April 4, 2016 Managed Care Insurance, Medical Provider Networks, Provider Networks, Health Plans 0 0 Comment Read More »
CMA defeats bill that would have transferred negotiating power to health plans at the expense of physicians The California Medical Association (CMA) has defeated a bill that would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. Assembly Bill 533 was an attempt to shield patients from billing disputes between providers and health plans and would have required non-contracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. Although CMA is in favor of removing patients from billing disputes between ... September 23, 2015 Managed Care Advocacy, Medical Provider Networks, State Legislation, Health Plans 0 0 Comment Read More »
