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 »
CMA Foundation launches free antibiotic clinical guidelines mobile app The week of November 17-23, 2014, is "Get Smart About Antibiotics Week" – a campaign to highlight the problem of antibiotic resistance and the importance of appropriate antibiotic use. Every year at least 2 million Americans become infected with antibiotic resistant bacteria and at least 23,000 people die from these infections. This cold and flu season, the California Medical Association (CMA) Foundation's Alliance Working for Antibiotic Resistance Education (AWARE) project reminds physicians and patients to reduce the unnecessary use of antibiotics. To assist physicians and other clinicians in these efforts, ... November 14, 2014 General AWARE, CMA Foundation, Public Health, Antibiotic Resistance 0 0 Comment Read More »
Medi-Cal UCR web app for CHDP primary care rate increases now available; deadline to submit is Nov. 28 The California Department of Health Care Services (DHCS) has taken steps to correct a problem with the Affordable Care Act primary care rate increase unique to Child Health and Disability Prevention Program Services (CHDP) providers. Before the rate increases were implemented, some practices were previously instructed by DHCS to bill at their Medi-Cal rates. This caused concern—based on DHCS's pricing logic of paying the lesser of Medicare’s rate or the billed charges—that some practices would not qualify for the retroactive increases once the systems were updated to process claims at ... November 14, 2014 General, Medi-Cal Child Health and Disability Prevention Program, DHCS, Medi-Cal, Affordable Care Act 0 0 Comment Read More »
United issues new Premium Designation physician results United Healthcare recently sent California physicians their latest Premium Designation assessment results. These latest results will be released publicly via the payor's online physician directory beginning January 1, 2015. Physicians within the designated 27 specialty areas, including ear, nose and throat (ENT) and gastroenterology (new for 2015), will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. Physicians meeting or exceeding these benchmarks will receive a Premium Designation notation on their physician profiles, marketed to UHC enrollees through the payor’s online physician ... November 14, 2014 General United Healthcare 0 0 Comment Read More »
Anthem to require NDC on claims for certain physician-administered drugs On September 30, Anthem Blue Cross notified physicians that effective January 1, 2015, it will require all professional providers to bill using the 11-digit National Drug Code (NDC) for drugs administered in a physician’s office. In the notice, Anthem says that currently, the lack of uniform coding system for drugs can result in inaccurate payments. The payor also states the change will allow it to be more consistent with Medicaid requirements and maintain consistent claims billing guidelines across all Anthem products. While the notice said the NDC would be required ... November 14, 2014 General Billing/Coding, Prescription Drugs, Anthem Blue Cross 0 0 Comment Read More »
Guidelines for Prescribing Controlled Substances for Pain News Release Thursday, November 13, 2014 Contact: Cassandra Hockenson Medical Board of California (916) 263-2394 Medical Board of California's Revised Guidelines for Prescribing Controlled Substances for Pain Sacramento - The Medical Board of California (Board) announces its release of its revised Guidelines for Prescribing Controlled Substances for Pain (Guidelines). These Guidelines were approved by the Board at its quarterly Board Meeting on October 24, 2014. The Board recognizes that the inappropriate prescribing of controlled substances, including opioids, is a consumer protection issue, and the Board takes this matter very seriously. The Board is aware that some ... November 14, 2014 General Consumer Protection, Pain Guidelines, Prescribing Controlled Substances 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 »
Supreme Court delays hearing ACA subsidy case The U.S. Supreme Court has declined to hear King v. Burwell—a case the questions whether premium subsidies can be provided under the Affordable Care Act (ACA) to individuals purchasing health insurance coverage on exchanges run by the federal government. The lawsuit has the potential to affect states that use the Federal health care exchange, but would not change the subsidies in states like California that run their own exchanges. The question asked in King v. Burwell is whether the language of the ACA law allows consumers to receive premium tax ... November 6, 2014 General Affordable Care Act, Health Insurance Exchange, ACA 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 »
