DHCS to automate Medi-Cal provider enrollment The California Department of Health Care Services (DHCS) will soon be automating its Medi-Cal provider enrollment processes. The hope is that the new system, expected to go live this fall, will improve the provider enrollment experience by minimizing errors in the application process and significantly reducing the time required to process provider enrollments. The new enrollment system, called the Provider Application and Validation for Enrollment (PAVE) system, will be a web-based portal that providers can use to submit application and verifications and report changes. Initially, PAVE will only be available for ... March 27, 2014 Medi-Cal Medi-Cal, DHCS, Medi-Cal Provider Enrollment 0 0 Comment Read More »
Covered California patients have until March 31 to switch plans Covered California patients have until March 31 to switch exchange plans if they made selections based on an inaccurate provider directory. On February 7, following numerous complaints about accuracy from both enrollees and providers, Covered California removed its provider directory from the exchange website. However, some patients had already selected plans based on inaccurate provider directory information. CMA has received multiple inquiries from practices asking whether these patients have any options. The answer is yes. Patients can contact the Covered California’s Service Center at (800) 300-1506 to switch to a ... March 27, 2014 General Health Insurance Exchange, Covered California 0 0 Comment Read More »
CMA sponsors bill to increase primary care residency slots in California Today is National Match Day, the day when thousands of California medical students learn whether they can begin their practice of medicine here or must move to training programs in other states. National Match Day is the day graduating medical students nationwide learn the location of their residency programs, the next step in training after four years of medical school. Because of funding constraints, California – where significant areas of the state already face physician shortages, especially in primary care – lacks a sufficient number of primary care residency opportunities ... March 27, 2014 General Physician Workforce, Residents and Fellows, State Legislative Advocacy, Medical Students 0 0 Comment Read More »
Aetna seeks to terminate its proposed $120 million class settlement over use of Ingenix to underpay out-of-network claims Late last year, Aetna, Inc. announced a proposed class settlement of up to $120 million over its use of the flawed Ingenix database. The nationwide settlement would have required Aetna to reimburse providers and Aetna PPO subscribers for losses arising from Aetna's underpayment for out-of-network medical care. A hearing had been scheduled for March 18, 2014, in the U.S. District Court in New Jersey for the court to determine whether final approval of the settlement should be granted. Less than a week before the hearing, however, Aetna notified the ... March 27, 2014 General Ingenix, Insurance/Reimbursement, Legal Advocacy, Aetna 0 0 Comment Read More »
California Immunization Coalition Summit coming in May The 2014 California Immunization Summit will be held on May 4-5 in Sacramento. This annual summit is an opportunity for physicians to learn about community-based programs that have increased vaccination rates, and how to adapt and apply key lessons from successful programs. The summit is presented by the California Immunization Coalition, a public-private partnership dedicated to achieving and maintaining full immunization protection for all Californians to promote health and prevent serious illness. This year's program, “Harnessing the Power of Community,” includes two keynote speakers, Melinda Wharton, M.D., M.P.H., acting director ... March 27, 2014 General Public Health, Vaccination, Immunization 0 0 Comment Read More »
CMA surveys health plans on implementation plans for CMS 1500 claim form The California Medical Association (CMA) surveyed the major payors in California to find out which of them will follow the Centers for Medicare and Medicaid Service’s (CMS) lead and require submission of paper claims on the new CMS 1500 form (version 02/12 OMB control number 0938-1197). CMS will no longer accept claims on the old forms effective April 1. CMA’s survey found that some health plans will require the new 1500 version on April 1, others will allow for continued submission of the previous version. To view a detailed breakdown ... March 27, 2014 Medi-Cal, Medicare ICD-10, Practice Resources, CMS, Insurance/Reimbursement 0 0 Comment Read More »
CMA files brief in case of intentional retaliatory actions by hospital CEO against physician leader On Monday California Medical Association (CMA) filed an amicus brief with the California Court of Appeal in the case of Michael W. Fitzgibbons, M.D. v. Integrated Health Care Holdings, Inc. (IHHI), arguing that a hospital must be held vicariously liable for the intentional, retaliatory actions of the hospital’s CEO against a vocal physician leader on the hospital’s medical staff. In 2005, troubled Tenet Corp. sold Western Medical Center of Santa Ana (WMC) and three other Orange County hospitals to IHHI. Dr. Fitzgibbons, then chief of WMC’s medical staff, became concerned ... March 27, 2014 General CMA Legal Case List, Legal Advocacy, Amicus Briefs 0 0 Comment Read More »
Three major exchange plans provide guidance for physicians Three major managed care payors offering coverage through Covered California have provided additional information to their contracted providers on their exchange/mirror products. Together, these three payors – Health Net, Anthem Blue Cross and Blue Shield of California – account for approximately 75 percent of enrollment in Covered California products to date. The notices, sent to physicians within the past few weeks, were cobranded with Covered California and contain additional information to help providers navigate the exchange. The Health Net notice, sent on March 7, includes information such as the exchange/mirror products ... March 20, 2014 Managed Care Blue Shield, Covered California, Health Insurance Exchange, Health Net, Anthem Blue Cross 0 0 Comment Read More »
CMA attends California Democratic, Republican Party Conventions to showcase health care efforts The California Medical Association (CMA) sent a large contingent of physicians, medical students and staff to the California Democratic Party Convention in Los Angeles, March 7-9. As the trial lawyers are major Democratic party financial contributors, our presence was critical to the ongoing battle over the Medical Injury Compensation Reform Act (MICRA). Joining the group of 3,000 California Democratic delegates and guests, CMA’s physicians and medical students, donning their crisp white lab coats, had a major presence. Roaming the halls, lining the backs of caucus rooms and speaking to delegates, ... March 20, 2014 General Advocacy, Legislative Advocacy, Professional Liability 0 0 Comment Read More »
IMQ launches online course on reporting child abuse and neglect The California Medical Association Institute for Medical Quality (IMQ) is offering a new online course to prepare physicians for identifying and reporting suspected cases of child abuse and neglect. This program, "Mandated Reporting of Child Abuse and Neglect," is offered through a joint partnership with the Child Abuse Prevention Center, an international training, education, research and resource center dedicated to protecting children and building healthy families. Participants can earn 1.25 AMA PRA Category 1 CreditsTM. Click here to register. IMQ Online Education provides access to courses for AMA PRA Category ... March 20, 2014 General Institute for Medical Quality, Education and Events 0 0 Comment Read More »
