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Health Net addresses problems with explanation of payment

On August 21, 2018, Health Net notified providers that some paper explanation of payment (EOPs), commonly known as explanations of benefits, for commercial exchange enrollees were not displaying amounts correctly. This problem prevented providers from properly reconciling the amount Health Net is responsible for or the patient cost-sharing.  Health Net reports it has resolved all issues related to the misprinted EOPs, except in instances where the enrollee’s cost share may not be correctly displaying a figure that includes any coinsurance amount. Health Net advises that a fix for the cost ...

UnitedHealthcare to discontinue use of fax numbers for medical prior authorization requests

UnitedHealthcare announced in its September 2018 Network Bulletin that it will begin retiring fax numbers utilized for medical prior authorization requests beginning January 1, 2019. Providers will be directed to utilize the Prior Authorization and Notification tool on Link, the UHC website currently utilized to check eligibility and benefits, manage claims and update provider demographic information. The following fax numbers will be retiring as of January 1, 2019: (877) 269-1045 (866) 362-6101 (866) 892-4582 (866) 589-4848 ...

L.A. Care issues recoupment letters for services dating back to 2012

The California Medical Association (CMA) has learned that L.A. Care Health Plan, the publicly operated Medi-Cal health plan serving more than 2 million Los Angeles County residents, issued letters to physicians in late July requesting the refund of claim overpayments dating back to 2012. The letters, dated July 28 and received by practices through mid-August, cited that the overpayments were a result of processing errors, including the following: L.A. Care incorrectly processed Medi-Medi claims as the primary payor instead of secondary to Medicare. ...

Health Net Federal Services continues to address TRICARE transition issues

As previously reported, Health Net Federal Services (HNFS) has experienced implementation issues since taking over as the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region on January 1. In recent discussions with the California Medical Association (CMA), HNFS said it continues to address the breakdowns in process and resulting consequences that have impacted TRICARE providers in the areas of provider contracting and credentialing, beneficiary reassignment and provider directory inaccuracies. Updates are as follows: Contracting and Credentialing Because of staffing and operational issues, physicians may have experienced ...

CA pharmacy board launched drug take-back database

The California Board of Pharmacy has launched an online drug take-back tool to help consumers looking for a place to safely dispose of unwanted or expired prescription drugs. The searchable online database includes pharmacies statewide offering drug take-back services authorized by the California State Board of Pharmacy. The drug take-back search tool is available at pharmacy.ca.gov. Users can enter a pharmacy name, city or zip code to easily find a nearby location for disposing of unused medications. Pharmacies operating take-back programs registered with the Board of Pharmacy may offer two types ...

CMA and AMA oppose CMS proposal to collapse E/M codes

More than 150 health care organizations, including the California Medical Association (CMA) and the American Medical Association (AMA), sent a joint letter to the Centers for Medicare and Medicaid Services (CMS), opposing the agency’s proposal to collapse evaluation and management (E/M) code and payment levels. The proposal was included in the draft 2019 Medicare Physician Fee Schedule and MACRA Quality Payment Program rule released earlier this summer. CMA and AMA appreciate CMS’s genuine desire to reduce documentation burdens on physicians to allow them to focus on patients over paperwork. Several ...

New Medi-Cal provider enrollment system to go live Sept. 4

The California Department of Health Care Services (DHCS) is releasing an update to its Medi-Cal provider enrollment system—called the Provider Application and Validation for Enrollment (PAVE)—on Tuesday, September 4, 2018.  The current iteration (2.0) of the PAVE system, launched on November 18, 2016, transformed DHCS’ provider enrollment from a manual paper-based process to a web-based portal that providers could use to complete and submit their applications, verifications and to report changes. Version 2.0 included most physicians and allied provider types. The new 3.0 update will include even more eligible provider ...

Senator Holly Mitchell to keynote 2018 NEPO Summit

Physicians for a Healthy California is thrilled to announce that California State Senator Holly Mitchell (D-Los Angeles) is joining the 2018 Network of Ethnic Physician Organizations (NEPO) Summit as keynote speaker. Senator Mitchell is a strong advocate for children, passionate defender of women’s rights and the environment, and fighter for equity and justice. She is also the founder and chair of the Senate Select Committee on Women and Inequality. The 2018 NEPO Summit will be held September 13-15 in Pasadena. This year's theme, Building the Best You: Celebrating the Joy ...

UnitedHealthcare Community Plan preps for entry into additional Medi-Cal and Medicare Advantage markets

Looking to potentially enhance its footprint in the Medi-Cal and Medicare Advantage marketplace by 2021, UnitedHealthcare (UHC) Community Plan of California has issued unilateral contract amendments to contracted physicians in seven California counties. Additionally, UHC providers in the seven counties who are not currently contracted for the Medicare Advantage product will receive a combined contract amendment for participation in both UHC Community Plan of California (Medi-Cal) and UHC Medicare Advantage products. As a condition of participation in the Medi-Cal Managed Care request for proposal process in late 2019 or early 2020, ...

Have you updated your My CMA profile yet?

The California Medical Association’s (CMA) new website is loaded with a suite of digital tools that will help you get the most from your membership. One exciting new feature is the My CMA dashboard. If you haven’t already, please login, update your profile, and chose your preferences and areas of interest. By doing so, we will be able to deliver custom content and personalized alerts to your My CMA dashboard based on your user preferences. On your My CMA dashboard, you will also be able to find all of your ...