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 »
California physicians oppose health plan mega-mergers, citing reduced access to affordable high-quality health care SACRAMENTO — Eighty-five percent of California’s physicians are opposed to the merger of health insurance giants Anthem and Cigna, according to a new analysis released by the California Medical Association (CMA) on Monday. The CMA survey, conducted in collaboration with the American Medical Association (AMA), sought to gauge California physicians’ perspective on the proposed Anthem-Cigna and Aetna-Humana mergers, as well as gather insight into the tactics undertaken by insurance companies’ in their negotiations with physicians. “California’s doctors could not be more clear: these mergers are bad for patients and bad for ... March 31, 2016 Managed Care Cigna, Mergers, Anthem 0 0 Comment Read More »
Blue Shield experiencing multiple claims processing issues, some delaying payment The California Medical Association (CMA) began receiving calls in early February from physicians reporting that the explanation of benefits (EOBs) they were receiving on PPO claims from Blue Shield of California were missing EOB reason codes and information regarding the provider dispute resolution process. Blue Shield reports that only the EOB was affected, not the issuance of payment. CMA has since learned that there were two other system issues causing delays in payment on a large number of Federal Employee Program (FEP) and out-of-state BlueCard claims. All three of these issues ... March 31, 2016 Managed Care BlueCard, Blue Shield 0 0 Comment Read More »
Final regulations requiring health insurers to have adequate networks and accurate directories go into effect The California Department of Insurance (CDI), which regulates most PPOs in the state, issued permanent regulations this week that require health insurers to develop and maintain adequate provider networks. This move comes after emergency regulations were issued in January 2015 to help ensure patients can get timely access to care. While the California Department of Managed Health Care (DMHC), which regulates HMOs and certain PPO products, has had in place network adequacy standards for a number of years, CDI has not. These regulations will thus ensure that Californians, regardless of ... March 31, 2016 Managed Care Medical Provider Networks, Network Adequacy, Provider Networks, Department of Insurance 0 0 Comment Read More »
California lawmakers unveil bill to tax MCOs and plug $1.1 billion hole in budget California lawmakers on Monday unveiled two identical bills to replace the soon-to-expire tax on managed care organizations (MCO). The bills, ABx2 20 (Bonta) and SBx2 15 (Hernandez), are the product of 14 months of negations with MCOs. These bills are supported by the California Association of Health Plans, with most member plans either supportive or neutral. The current MCO tax will expire this summer if legislators cannot agree on a replacement. Since 2005, the state has taxed MCOs and used the money to cover the costs of the Medi-Cal program. ... February 16, 2016 Managed Care, Medi-Cal Medi-Cal, State Legislation, Managed Care, Managed Care Organization (MCO) 0 0 Comment Read More »
UHC to require prior authorization for select musculoskeletal and pain management procedures As indicated in its January 2015 Network Bulletin, United Healthcare (UHC) will begin requiring prior authorization for certain additional musculoskeletal and pain management procedures effective April 4, 2016. Included in the new prior authorization requirement are various arthroscopy procedures, spine-related surgeries, neurostimulators for back pain and certain foot surgical procedures. For a complete listing of procedures requiring notification, physicians can access the Advance Notification Requirements on the UHC website. Prior authorization will be required for services performed in all places of service settings, including inpatient/outpatient hospitals, ambulatory surgery centers ... February 9, 2016 General, Managed Care Preauthorization, United Healthcare, Pain Medicine 0 0 Comment Read More »
Blue Shield revises Provider Data Confirmation form In December 2015, the California Medical Association (CMA) began receiving calls from physicians who had received requests from Blue Shield of California to complete its Provider Data Confirmation form. According to Blue Shield, the requests are an effort to comply with Senate Bill 137, a new law that requires payors to maintain accurate provider directories (among other things). Blue Shield is asking that participating providers review and complete the form to indicate whether the data it has on file for each provider is accurate, incorrect or incomplete. Some physicians, ... February 9, 2016 Managed Care Blue Shield 0 0 Comment Read More »
CMA seeking physician feedback on proposed health insurance mergers Proposed mergers of the some of the largest national health insurance companies have been announced, with Aetna reaching a $37 billion deal to purchase Humana, and Anthem agreeing to purchase Cigna for $48.4 billion. State and federal regulators are interested in knowing the prospective effects of these possible mergers on your practice and patient care. The California Medical Association (CMA), in collaboration with the American Medical Association, is asking for your feedback on these proposed mergers. The survey should take about 8-9 minutes to complete. Only de-identified data will be used ... February 9, 2016 Managed Care Anthem Blue Cross, Cigna, Humana, Aetna 0 0 Comment Read More »
Reminder: Exchange patients, eligibility and the 90-day grace period Practices are reminded that under the Affordable Care Act, exchange enrollees who receive federal premium subsidies (approximately 90 percent of enrollees) to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums. In the first month of the grace period, federal law and California regulations require plans to pay for services incurred even if the patient fails to pay the premiums due by day 90 (CCR §1300.65.2(b)(1)(A)). But in months two and three of the grace period, plans can ... February 3, 2016 General, Managed Care Affordable Care Act, Grace Period, ACA 0 0 Comment Read More »
UHC to introduce new primary care assessment program United Healthcare (UHC) recently notified approximately 800 contracted primary care physicians, introducing them to its new educational performance evaluation program. Slated to run concurrently with the UHC Premium Designation program, primary care physicians whose claims data demonstrates a high utilization rate in one of the following measures will receive a performance evaluation report: Emergency department utilization Inpatient admission utilization Average length of stay Laboratory/pathology utilization Levels 4 and 5 visits Modifier ... January 15, 2016 Managed Care United Healthcare 0 0 Comment Read More »
