Next phase of Healthy Families to Medi-Cal transition scheduled for August 1 Phase 3 of the Healthy Families transition from fee-for-service to Medi-Cal managed care is scheduled for August 1, 2013. This phase will impact approximately 107,000 children who have a Healthy Families plan that does not offer Medi-Cal managed care or subcontract with a Medi-Cal managed care plan, thus requiring them to transition to a new plan. This is the first phase of the Healthy Families transition where patients may be required to change physicians. Enrollment will include consideration of the child’s primary care providers. Affected counties are: ... July 9, 2013 Managed Care, Medi-Cal Managed Care, Medi-Cal, Healthy Families 0 0 Comment Read More »
Update your NPI information before the Medicare transition to Noridian According to a new report by the U.S. Department of Health & Human Services Office of the Inspector General, 58 percent of the databases used to determine provider identities and help to prevent the occurrence of fraud are inaccurate or incomplete. The National Plan and Provider Enumeration System (NPPES), which houses National Provider Identifier (NPI) numbers, is not always consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS). The national revalidation effort by the Centers for Medicare & Medicaid Services (CMS) is a big step in improving ... July 9, 2013 Medicare Medicare, NPI, Noridian 0 0 Comment Read More »
AMA's new "administrative burden index" ranks cost of doing business with commercial insurers The American Medical Association (AMA) recently unveiled its new Administrative Burden Index (ABI), which ranks commercial health insurers according to the level of unnecessary cost they contribute to the billing and payment of medical claims. The ABI reflects the overhead cost needed to bill and collect payment from each major payer and was introduced as part of AMA's annual National Health Insurer Report Card. AMA found that administrative tasks associated with avoidable errors, inefficiency and waste in the medical claims process resulted in an average ABI cost per claim of ... July 8, 2013 General Billing and Coding, AMA, Insurance/Reimbursement, Practice Management 0 0 Comment Read More »
Budget deal jump starts special session bills Almost six months have passed since Gov. Jerry Brown opened a special session on health care reform in California, and members of the state Legislature are now beginning to tie up the final loose ends. Of the three sets of bills put forward under the special session’s parameters, all but one appeared to be stalled indefinitely until members of the Legislature reached a budget deal. These bills, which outlined California’s plans to expand the Medi-Cal program and establish a so-called "bridge plan" between Medi-Cal and exchange plans, were sprung from ... July 8, 2013 Medi-Cal Health Insurance Exchange, Affordable Care Act, Health Care Reform, Medi-Cal 0 0 Comment Read More »
Physicians are encouraged to check Covered California's provider database in July As previously reported, there remain some uncertainties around the process of physician contracting with exchange plans. Beginning sometime in July, the exchange should alleviate much of the uncertainty as to who is and is not considered to be an exchange provider. This is because Covered California will be unveiling a centralized online provider database for the first time in July. Using this database, exchange patients will be able to see which providers are included in the respective exchange plans’ networks. This centralized database will also be utilized by the exchange’s eligibility ... July 8, 2013 Managed Care Health Care Reform, Health Insurance Exchange, Affordable Care Act, Covered California 0 0 Comment Read More »
