Survey: ER visits continue to climb under Affordable Care Act A recent survey conducted by the American College of Emergency Physicians (ACEP) shows that emergency room (ER) visits are continuing to climb since the implementation of the Affordable Care Act (ACA), despite predictions that the law would result in less crowding. According to a news release, about three-quarters of the 2,098 ER physicians surveyed said that visits have risen since January 2014 — a significant increase from a year earlier, when less than half said they saw an upturn. More than one-quarter reported “significant increases in all emergency patients” since ... May 15, 2015 General, Managed Care Affordable Care Act, Emergency Rooms, Health Care Reform, ACA 0 0 Comment Read More »
Covered California board proposes to cut budget because of slower enrollment Due to tepid enrollment numbers, Covered California’s board of directors has proposed to spend $58 million less in 2016, slashing its marketing and outreach program by 33 percent. Open enrollment in Covered California fell short of its goal of 1.7 million this year, ending with the number of enrollees at 1.4 million. Additionally, the exchange must pay its own way in the future after receiving $1 billion in federal money. And while it still has some $290 million in reserve for 2016, the exchange projects that fewer than 1.5 million ... May 15, 2015 General, Managed Care Covered California, Health Insurance Exchange, Affordable Care Act 0 0 Comment Read More »
Changes to Anthem Blue Cross reimbursement policies and claims software Anthem Blue Cross recently notified physicians of upcoming changes to the insurer’s reimbursement policies and claims editing software, called ClaimsXten. The changes will go into effect on July 1, 2015. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. Along with the notice, Anthem provided a comprehensive grid outlining the new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies. The changes include additions to the types of service Anthem will consider bundled ... May 15, 2015 Managed Care Billing/Coding, Insurance, Managed Care, Anthem Blue Cross 0 0 Comment Read More »
United Healthcare automatically opts physicians into Core narrow network product United Healthcare (UHC) recently issued notifications to 19,000 practices included in its commercially contracted provider network, advising of their inclusion in the UHC Core product. The new UHC Core plan will access a significantly narrowed network and will be marketed to employer groups seeking lower premiums for their employees. Additionally, indications are that UHC will also utilize the narrowed Core network for its potential future exchange products in 2016. UHC advised the California Medical Association (CMA) that reimbursement for the Core product line will be at the commercial fee ... April 23, 2015 General, Managed Care Health Insurance Exchange, United Healthcare, Exchange Plans 0 0 Comment Read More »
Anthem system error results in missing remittances In early February, the California Medical Association (CMA) began receiving reports from practices of missing Anthem Blue Cross remittances. CMA escalated the issue to the payor and has since learned that a system issue is to blame for the missing electronic remittance advices (ERA). Anthem reports that the problem began in mid-December and affected ERAs for exchange/mirror and Federal Employee Program (FEP) claims. Somehow, the ERA function was turned off in the Anthem system for these product types. So, while practices received the money for the affected claims through ... March 17, 2015 Managed Care Anthem Blue Cross, Insurance/Reimbursement, Managed Care 0 0 Comment Read More »
Gallup poll finds U.S. uninsured rate at lowest level in seven years. According to a nationwide Gallup Poll, the Affordable Care Act (ACA) has steadily reduced the number of people without insurance across the United States. The group conducted phone interviews (landline and cell) in 2013 and 2014, as part of the Gallup-Healthways Well-Being Index, with a random sample of 178,072 adults in 2013 and 176,702 adults in 2014. The survey found that the nationwide rate of uninsured adults declined from 17.3 percent in 2013 to 13.8 percent in 2014. The lowest uninsured rates continue to be primarily in the Northeast and ... March 9, 2015 Managed Care Insurance, Uninsured, Affordable Care Act 0 0 Comment Read More »
Covered California rolls gain 1.4 million people; enrollment extended through end of April Covered California announced that it had 1.4 million people on its rolls and that it had extended the deadline to buy health insurance for people who say they weren't aware they would face a tax penalty. According to Peter Lee, executive director of Covered California, as many as 600,000 California residents face a penalty under the Affordable Care Act for not having insurance. The extension does not exempt people from paying the 2014 tax penalty, but would help them avoid bigger penalties in 2015. On the national front, the White ... February 23, 2015 Managed Care Health Insurance Exchange, Covered California 0 0 Comment Read More »
United Healthcare to pursue EFT and ERA for all contracted physicians in 2015 United Healthcare (UHC) plans to move all contracted providers from paper checks and remittances to electronic funds transfer (EFT) and electronic remittance advices (ERA) in 2015 through Optum’s Electronic Payments and Statement (EPS) system. United Healthcare stated that moving to an electronic process for checks and explanation of benefits will reduce administrative costs. UHC advised the California Medical Association that they plan to send notice of the change to contracted providers sometime in April. Physicians will be required to select to receive payment either by Automated Clearinghouse (ACH) direct ... February 5, 2015 Managed Care Payment, United Healthcare, Insurance/Reimbursement 0 0 Comment Read More »
United Healthcare amendment introduces narrow network product Setting the stage for its potential future entrance into California’s Exchange, Covered California, United Healthcare (UHC) has begun the process of building its provider networks by amending physician contracts. United Healthcare has advised CMA that its new Core plan, which will be marketed to employer groups seeking lower premiums and used for its potential future exchange product, will access a significantly narrowed network of approximately 45 percent of UHC’s current PPO provider network. UHC plans to send amendment notices to physicians selected to participate in the Core network sometime in ... February 4, 2015 Managed Care United Healthcare, Provider Networks 0 0 Comment Read More »
New prescription drug prior authorization form required on Jan. 1 for DMHC regulated products On January 1, 2015, a new law will fully take effect that streamlines and standardizes the prior authorization process for prescription drugs. The law (SB 866) requires all insurers, health plans (and their contracting medical groups/IPAs) and providers to use a standardized two-page form for prior authorizations of prescription medications. The law also requires plans and insurers to make a determination on prescription drug prior authorization requests within two days of receipt, and if they fail to do so the requests will be deemed authorized. The new law does not ... December 16, 2014 General, Managed Care Prescription Drugs, Preauthorization 0 0 Comment Read More »
