New online Medi-Cal provider enrollment portal launch planned for October 2016 The California Department of Health Care Services (DHCS) plans to launch its new Medi-Cal provider enrollment system in October. The Provider Application and Validation for Enrollment (PAVE) system will transform provider enrollment from a manual paper-based process to a web-based portal that providers can use to complete and submit their applications and verifications and to report changes. PAVE will improve the provider enrollment experience by minimizing errors, improving the application process and significantly reducing the time required to process provider enrollments. Testers needed DHCS is seeking Medi-Cal fee-for-service providers who are ... August 9, 2016 Medi-Cal Medi-Cal Provider Enrollment, Medi-Cal 0 0 Comment Read More »
UHC to require prior authorization for select outpatient surgical procedures As indicated in its July 2015 Network Bulletin, United Healthcare (UHC) will begin requiring prior authorization for certain surgical procedures done in a hospital outpatient setting effective October 1, 2016. The new prior authorization requirement includes procedure codes in cardiovascular, cosmetic and reconstruction, ophthalmology, and ENT (ear, nose and throat) specialties. Prior authorization will not be required to perform the identified procedures if done in an in-network ambulatory surgery center. For a complete listing of procedures requiring prior authorization, physicians can access the Prior Authorization for Outpatient Surgical Procedures FAQ ... August 9, 2016 Managed Care United Healthcare, Preauthorization 0 0 Comment Read More »
Health Net Federal Services awarded Tricare contract beginning late 2017 Health Net Federal Services (HNFS) has been awarded the contract for managed care support (MCS) for the Tricare West Region, replacing the current MCS contractor, United Military and Veteran Services. Under the $17.7 billion contract, HNFS will provide direct medical care and administrative support services to Tricare beneficiaries throughout the 19 state western region, which includes California. According to HNFS, a nine-month transition period is expected, with an anticipated start of health care delivery sometime in mid-2017. HNFS has been the managed care contractor for the Tricare North Region since ... August 9, 2016 Managed Care Tricare, Health Net 0 0 Comment Read More »
Blue Shield implements system fix to correctly pay HPV9 claims Under the Affordable Care Act, health plans are required to provide “first dollar” coverage for preventive services. This means that the plan cannot apply patient cost sharing, such as copays, coinsurance or deductibles, to these services. However, in September 2015, the California Medical Association (CMA) was alerted by a physician practice that Blue Shield of California was applying patient cost sharing when it processed HPV9 claims with CPT code 90651. CMA escalated the issue to Blue Shield and has been working with the payor since then to correct the ... August 9, 2016 Managed Care Affordable Care Act, Blue Shield, ACA 0 0 Comment Read More »
Anthem Blue Cross announces changes to reimbursement policies and claims software effective October 1, 2016 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 October 1, 2016, with the exception of policies for Multiple Diagnostic Ophthalmology Procedures (CA–0050) and Multiple Diagnostic Cardiovascular Procedures (CA-0051), which become effective on October 17, 2016. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated. The notice included a comprehensive grid outlining the new, revised and existing reimbursement policies and claims editing rules, ... August 9, 2016 Managed Care Anthem Blue Cross 0 0 Comment Read More »
California to get federal funds to help identify and treat babies born with microcephaly The Centers for Disease Control and Prevention (CDC) announced that it has awarded more than $16 million to 40 states and territories, including California, to establish, enhance and maintain information-gathering systems to rapidly detect microcephaly – a serious birth defect of the brain – and other adverse outcomes caused by Zika virus infection. According to the announcement, the California Department of Public Health will receive $720,000. The funding will help states and territories ensure that infants and their families are referred to appropriate health and social services. The awards will ... August 8, 2016 Awards, General Public Health, Zika Virus, Maternal and Child Health 0 0 Comment Read More »
CMA Foundation awards 5 new medical student community leadership grants The California Medical Association (CMA) Foundation has awarded five new medical student grants as part of its Medical Student Community Leadership Grant Program. The program provides grant funding to California medical students to support health-related educational, advocacy, community service and other outreach programs that enhance the well-being of California communities. Grant applications are reviewed on a semi-annual basis; the next application deadline is October 31, 2016. Newly funded projects include: Time Is Heart: Medical students at California Northstate University College of Medicine will perform educational outreach to ... August 8, 2016 Awards Medical Students, CMA Foundation (CMAF) 0 0 Comment Read More »
Covered California announces plan offerings for 2017 Covered California, the state marketplace for health insurance under the Affordable Care Act, recently announced the qualified health plans that were approved to offer coverage in the exchange market for 2017. All of the plans that offered coverage in 2016 will continue to do so in 2017. Three of the plans will also be expanding into new regions this year. Molina is expanding its HMO coverage into Orange County (region 18) through delegated relationships with Monarch and Heritage Network ... August 8, 2016 Managed Care Affordable Care Act, Covered California, Exchange Plans, Molina, Oscar, ACA, Kaiser Permanente 0 0 Comment Read More »
Last chance for some providers to prevent deactivation by Medicare Noridian, Medicare’s administrative contractor for California, will soon begin deactivating billing privileges for physicians who received revalidation notices from Noridian but have not submitted completed applications to the Centers for Medicare and Medicaid Services (CMS). Last month, Noridian reported that only 19 percent of providers had responded to the most recent Medicare Part B revalidation notices. Since the passage of the Affordable Care Act (ACA), all Medicare providers and suppliers have been required to revalidate their Medicare enrollment information under new enrollment screening criteria in an effort to prevent ... August 8, 2016 Medicare Noridian, Medicare 0 0 Comment Read More »
CMA publishes MACRA preparation checklist On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), changing the health care financing system in the most significant and far-reaching way since the program's inception in 1965. To help physicians understand MACRA payment reforms, and what they can do now to start preparing for the transition, the California Medical Association (CMA) has published an important checklist titled, “MACRA: What Should I Do Now to Prepare?” The checklist is available in CMA's MACRA resource center at www.cmanet.org/macra. There you will ... August 8, 2016 CMA, Medicare Practice Resources, Running a Practice, MACRA, Medicare 0 0 Comment Read More »
