Are you being paid correctly under California's new out-of-network billing and payment law? Effective July 1, 2017, California’s new out-of-network billing and payment law (AB 72) requires fully insured commercial plans and insurers to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. The interim rate is the greater of the payor’s average contracted rate or 125 percent of the amount that Medicare reimburses on a fee-for-service basis for the same or similar services in that geographic region. This law ... January 29, 2018 CMA, General Economic Advocacy, AB 72, Medical Provider Networks, Out of Network Care, Provider Networks 0 0 Comment Read More »
Physicians apprehensive regarding requests for provider directory information The California Medical Association (CMA) continues to receive inquiries from practices concerned about the validity of requests for payors to confirm physician demographic information. The requests are related to the new provider directory accuracy law that took effect on July 1, 2016 (SB 137). Under the new law, physicians are required to respond to plan and insurer notifications regarding the accuracy of their provider directory information either by confirming the information is correct or by updating demographic information as appropriate. As with any request for protected information, practices should verify ... August 9, 2017 General Medical Provider Networks, Network Adequacy, Prov ider Directories, Provider Directory Accuracy Law, Provider Networks 0 0 Comment Read More »
Health plan group pilots program to improve physician directories America's Health Insurance Plans (AHIP) is launching a pilot program to ensure that physician directories are more accurate and up-to-date, the organization announced last week. The pilot program involves two directory vendors, BetterDoctor and Availity, and will include providers in three states: California, Florida and Indiana. The pilot program will run from April to September, according to AHIP, and will include the following eight California plans: Anthem Blue Cross Blue Shield of California Health Net of California Humana ... April 4, 2016 Managed Care Insurance, Medical Provider Networks, Provider Networks, Health Plans 0 0 Comment Read More »
Final regulations requiring health insurers to have adequate networks and accurate directories go into effect The California Department of Insurance (CDI), which regulates most PPOs in the state, issued permanent regulations this week that require health insurers to develop and maintain adequate provider networks. This move comes after emergency regulations were issued in January 2015 to help ensure patients can get timely access to care. While the California Department of Managed Health Care (DMHC), which regulates HMOs and certain PPO products, has had in place network adequacy standards for a number of years, CDI has not. These regulations will thus ensure that Californians, regardless of ... March 31, 2016 Managed Care Medical Provider Networks, Network Adequacy, Provider Networks, Department of Insurance 0 0 Comment Read More »
Anthem asking physicians to affirm participation in workers' comp MPNs by Dec. 31 Anthem Blue Cross recently sent a request to physicians who participate in various workers’ compensation medical provider networks (MPN) through their Prudent Buyer agreements, asking them to affirm their continued participation in each of these networks. This request is required as part of the reforms instituted under SB 863, which mandates that MPNs obtain written acknowledgement from each participating physician that the provider elects to be a member of the network. Under the resulting regulations, physicians who have entered into contracts with workers’ compensation payors prior to August 27, 2014, and ... December 7, 2015 Managed Care Medical Provider Networks, MPN, Workers' Compensation, Anthem Blue Cross 0 0 Comment Read More »
CMA defeats bill that would have transferred negotiating power to health plans at the expense of physicians The California Medical Association (CMA) has defeated a bill that would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. Assembly Bill 533 was an attempt to shield patients from billing disputes between providers and health plans and would have required non-contracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. Although CMA is in favor of removing patients from billing disputes between ... September 23, 2015 Managed Care Advocacy, Medical Provider Networks, State Legislation, Health Plans 0 0 Comment Read More »
Regulations requiring health insurers to have adequate networks and accurate directories go into effect Emergency regulations requiring health insurers regulated by the Department of Insurance to create and maintain adequate medical provider networks to provide timely access to medical care went into effect this week, after their approval by the Office of Administrative Law. California Insurance Commissioner Dave Jones issued the emergency regulations in early January. "Californians and California businesses deserve better than what they have gotten from most health insurers and HMOs,” Jones said. "This emergency regulation is necessary to make sure that health insurers establish and maintain adequate medical provider networks to meet ... February 5, 2015 General Medical Provider Networks, Network Adequacy, Out of Network Care, Department of Insurance 0 0 Comment Read More »
