Know Your Rights: Timely filing denials CMA’s “Know Your Rights” series summarizes vital protections under state and federal law that physicians should be aware of in their dealings with payors. Health plans typically impose claim filing deadlines, which require physicians to submit claims within a certain time period after the date of service. If the physician fails to meet the deadline, the health plan will not pay for the service provided. However, California law prohibits commercial health plans and insurers from imposing claim filing deadlines that are less than 90 days after the date of service ... November 16, 2016 General Denials, Know Your Rights 0 0 Comment Read More »
Know Your Rights: Managed care contractual protections CMA’s “Know Your Rights” series summarizes vital protections under state and federal law that physicians should be aware of in their dealings with payors. Thanks to legislation sponsored by the California Medical Association (CMA), all health plan contracts with physicians are required to be fair, reasonable and consistent with California law and regulations. Contractual clauses that are specifically prohibited cover the following: Claims filing deadlines that are inconsistent with the law (see "Unfair Payment Practice: Timely Filing Denials") Financial incentives to deny, reduce, limit ... October 13, 2016 Managed Care Know Your Rights, Managed Care, Payor Contracting 0 0 Comment Read More »
Know Your Rights: Making the most out of your appeals Thanks to California Medical Association (CMA)-sponsored legislation (AB 1455) signed into law in 2000 and the resulting regulations, payors are required to have a fast, fair and cost-effective dispute resolution mechanism (i.e., “appeal process”) to resolve provider disputes. Anytime a payor contests, adjusts or denies a claim, they are required to advise the provider of the availability of the appeal process and instructions for submitting the appeal. Payors are also required to acknowledge receipt of a written appeal within two working days for electronic appeals or 15 working days for ... September 13, 2016 CMA, General Know Your Rights, Appeals 0 0 Comment Read More »
