Be prepared for Covered California changes in 2015 In 2014, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals statewide in new health plans. With Covered California aiming to enroll an additional 500,000 during the 2015 open enrollment period, it is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2015. To help physicians understand the changes taking place and how they will affect their practice, the California Medical Association (CMA) has published a new tip sheet titled, “Surviving Covered California: Preparing for 2015.” December 16, 2014 Managed Care Health Insurance Exchange, Surviving Covered California, Covered California 0 0 Comment Read More »
DHCS identifies glitch in UCR web app for CHDP primary care rate increase payments The California Department of Health Care Services (DHCS) has identified an error in its web application that was designed to allow physicians the ability to enter their usual and customary rates (UCR) for Child Health and Disability Prevention Program Services (CHDP) claims. Physicians who already entered their UCR data prior to November 26, 2014, will need to return to the portal and reenter their information. The web app was developed to address a problem with the Affordable Care Act primary care rate increase unique to CHDP providers. Before the rate increases ... December 9, 2014 Managed Care, Medi-Cal Medi-Cal, Pediatrics, Affordable Care Act, Department of Health Care Services 0 0 Comment Read More »
Physicians encouraged to familiarize themselves with exchange plan changes heading into Covered California open enrollment Covered California began enrollment for its second year on November 15 and exchange officials are predicting a 45 percent jump in enrollment, from 1.2 million in 2014 to 1.7 million in 2015. Last year, open enrollment was a six-month process, this year it will be half as long, starting Nov. 15 and ending Feb. 15. In anticipation of this year's open enrollment, some payors have updated their exchange plan offerings for 2015, including plan types and plan names. The California Medical Association (CMA) will be publishing details of these changes ... November 17, 2014 Managed Care Affordable Care Act, Health Insurance Exchange, ACA, Covered California 0 0 Comment Read More »
CMA wants to hear from practices experiencing problems with the new prescription drug prior authorization form A new law recently took effect that streamlines and standardizes the prior authorization process for prescription drugs for most patients with PPO products. The new 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. If they fail to do so, the requests will be deemed authorized. The new law does ... November 14, 2014 Managed Care Prescription Drugs, Preauthorization 0 0 Comment Read More »
Blue Shield announces changes to 2015 exchange/mirror products On October 1, 2014, Blue Shield of California notified participating physicians that it was making changes to its Individual and Family Plan (IFP) EPO and PPO products, which are its exchange/mirror products. According to Blue Shield, the changes aim to expand access for EPO enrollees and reduce confusion by simplifying its plan names. Effective January 1, 2015, Blue Shield exchange/mirror EPO patients will have access to additional providers who are located outside of their county of residence. Previously, the Blue Shield IFP EPO limited in-network services to providers within ... November 14, 2014 Managed Care Covered California, Exchange Plans, Health Insurance Exchange, Blue Shield 0 0 Comment Read More »
United Healthcare to host webinars about its Premium Designation Program for contracted physicians At the request of the California Medical Association, United Healthcare (UHC) is inviting physicians and practice administrators to attend a special webinar presentation about its Premium Designation program in California. The webinars will be offered in mid-November and will provide an overview on the background and methodologies of the Premium Designation program and allow physicians an opportunity to ask specific questions they may have. The webinars will take place on the following dates and times. Participants will need to register with UHC prior to attending. Click the registration links below ... November 10, 2014 Managed Care Insurance/Reimbursement, Managed Care, Webinars, United Healthcare 0 0 Comment Read More »
Don't miss out on increased Medi-Cal payments - deadline to attest is December 31 The Department of Health Care Services (DHCS) reports that eligible physicians who have already attested have received over $283 million for services provided to fee-for-service Medi-Cal enrollees under the Affordable Care Act (ACA) primary care rate increase. Don't miss out! Remember, to qualify for enhanced payments for fee-for-service Medi-Cal and Medi-Cal managed care plans, you must first self-attest to your eligibility. The deadline to attest, if you haven't already done so, is December 31, 2014. Practices that have attested but have not yet received any additional funds are encouraged to ... November 6, 2014 Managed Care, Medi-Cal Attestation, DHCS, Medi-Cal, Department of Health Care Services 0 0 Comment Read More »
Health Net modifying exchange/mirror products Health Net recently announced changes to its exchange/mirror products offered for 2015. In a notice mailed to select physicians, the insurer said it will be offering an Exclusive Provider Organization (EPO) and a Health Care Service Plan (HSP) for its individual exchange/mirror products effective January 1, 2015. Though not explicitly stated in the notice, the California Medical Association (CMA) has confirmed the insurer will not be offering a PPO product in the individual exchange/mirror market. The EPO will be called PureCare One and the HSP will be called PureCare. Patients will ... November 5, 2014 Managed Care Health Insurance Exchange, Health Net, Covered California 0 0 Comment Read More »
System error causing some Anthem Blue Cross claims to be underpaid The California Medical Association (CMA) has received physician complaints that Anthem Blue Cross is applying a sequestration cut to their payments, causing some claims to be underpaid. The issue appears to affect claims in which Medicare is the patient’s primary plan and Anthem Blue Cross CalPERS is the supplemental plan. After Medicare processes the claim and forwards on, Anthem’s system appears to be applying a 2 percent sequestration cut to the amount they would normally pay as a supplemental plan in error. While the individual amounts are small, they can ... September 9, 2014 Managed Care Insurance/Reimbursement, Anthem Blue Cross 0 0 Comment Read More »
Legislature passes bill that would require annual reports from insurers on provider network adequacy The legislature has passed a bill that would require Medi-Cal managed plans and insurers offering individual plans through Covered California to provide annual reports to the California Department of Managed Health Care (DMHC) about the adequacy of their provider networks. The bill also requires DMHC to post annual reviews regarding plan compliance on its website. This California Medical Association (CMA) supported the bill, SB 964 (Hernandez), which passed late last week and is now on the governor's desk awaiting his signature. With roughly 1.4 million Californians newly enrolled in ... September 4, 2014 Managed Care Network Adequacy, Advocacy, Covered CA, Health Insurance Exchange 0 0 Comment Read More »
