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CMA objects to federal rule that would disrupt comprehensive women's health coverage

The California Medical Association (CMA) has filed formal comments objecting to a proposed federal rule that would change the way consumers are billed for health insurance exchange plans that cover abortion services. The proposed Exchange Program Integrity rule would require plans to send two separate monthly bills to each policyholder: one bill for the non-Hyde abortion coverage (at least $1 per member per month) and one bill for all other services. This would mean consumers would have to pay their monthly premium in two separate transactions. CMA believes the proposal threatens ...

Anthem issues new ID number for some patients

Anthem Blue Cross has issued new identification numbers and cards for a number of its members. New ID cards containing the new ID number were mailed to all affected members in late December. Providers are encouraged to make copies of each patient’s insurance card at the time of visit to verify the member’s identification number. Anthem advises that claims submitted with an incorrect ID number will be returned to the provider for correction and resubmission with the correct ID. Providers will need to contact their patients to obtain their updated ...

Golden Shore Medical Group to shut down following Molina contract termination

The California Medical Association (CMA) has learned that Molina Healthcare has terminated its contract with Golden Shore Medical Group. The plan filed requests in late 2018 with the California Department of Managed Health Care (DMHC) to transfer its enrollees to other delegated groups and the request was approved by the Department on January 11, 2019. According to Molina’s block transfer filing with DMHC, the termination was the result of the parties’ inability to agree on contractual terms. As a result of the termination, Golden Shore has announced to its network ...

UnitedHealthcare delays outpatient advanced radiology policy until February 1

Citing the need for additional time for communication and optimal rollout, UnitedHealthcare (UHC) has delayed implementation of its outpatient advanced radiology policy until February 1, 2019.  The new UHC policy—originally scheduled for implementation on Jan. 1—requires prior authorization for advanced imaging procedures, including certain magnetic resonance imaging, magnetic resonance angiography and computed tomography imaging procedures, when performed in the outpatient hospital setting.  Under UHC’s Outpatient Radiology Notification/Prior Authorization Protocol, a site of care review will be required for these advanced imaging services when performed in the outpatient hospital. Site of care ...

UnitedHealthcare to implement outpatient advanced radiology policy

Effective January 1, 2019, UnitedHealthcare (UHC) will require prior authorization for certain advanced imaging procedures when performed in the outpatient hospital setting. As highlighted in the UnitedHealthcare Network Bulletin October 2018, certain magnetic resonance imaging, magnetic resonance angiography and computed tomography imaging procedures will now be subject to a site of care review when performed in the outpatient hospital under UHC’s Outpatient Radiology Notification/Prior Authorization Protocol. Site of care reviews will not be done as part of the prior authorization process if a procedure will be performed in a free-standing diagnostic ...

First-ever TRICARE open enrollment begins November 12

Beginning November 12 and running through December 10, 2018, TRICARE will initiate its first ever open enrollment period for beneficiaries to enroll in or change their TRICARE Prime or TRICARE Select health plan coverage. Beneficiaries already enrolled who want to continue with their current plan without changes do not need to do anything. Any changes made during the 2018 open enrollment will be effective January 1, 2019. Outside of open enrollment, beneficiaries enrolled in Prime or Select will only be able to make a plan change if they have ...

Some Medi-Cal managed care plans slow to distribute Prop 56 funds

In May, the California Department of Health Care Services (DHCS) distributed the Proposition 56 supplemental funds for FY 2017-2018 to the Medi-Cal managed care plans. At the California Medical Association’s request, DHCS specified that plans must distribute the funds to providers within 90 days. However, the 90-day window ended August 31 and CMA has received complaints from physicians that some plans have still not issued supplemental payments. The supplemental payments are a result of the California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop 56), which created ...

IEHP completes termination of Vantage contract; three plans extend termination dates

The California Medical Association (CMA) has confirmed that Inland Empire Health Plan (IEHP) completed its contract termination with Vantage on August 31, 2018. IEHP transitioned its 273,000 covered lives to the following delegated groups: Receiving Provider Group Number of Enrollees Alpha Care Medical Group 80,190 La Salle Medical Associates 74,428 IEHP Direct 74,176 ...

What you need to know about Blue Shield of California's Care1st integration

On January 1, 2019, Blue Shield of California will complete the integration of Care1st Health Plan into its operations, and Care1st’s name will change to Blue Shield of California Promise Health Plan. The newly renamed health plan will remain a separate company and a wholly owned subsidiary of Blue Shield of California. Care1st physicians serving Medicare Advantage HMO, Medi-Cal or Cal MediConnect members will not need to contract with Blue Shield of California to continue providing services, and participating physicians will receive a mailed contract amendment later this year that ...

Coding Corner: CPT reporting for preventive medicine services

CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care. Preventive medicine services, or “well visits,” are evaluation and management (E/M) services provided to a patient without a chief complaint. The reason for the visit is not an illness or injury (or signs or symptoms of an illness or injury), but rather to evaluate the patient’s overall health, and to identify ...