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 »
AHIP conducting follow-up survey on Provider Directory Pilot America's Health Insurance Plans (AHIP) is conducting a follow-up survey of providers to evaluate the process and results of its earlier Provider Directory Pilot program. This program was aimed at meeting the requirements of California Senate Bill 137, which requires that physician directories are more accurate and up-to-date. AHIP has contracted with independent research organization NORC, at the University of Chicago, to reach out to providers as part of the evaluation phase of the provider directory pilot. Outreach to providers will include an online survey of provider office staff who ... November 16, 2016 General, Managed Care Network Adequacy, Provider Directories, Provider Directory Accuracy Law 0 0 Comment Read More »
CMA publishes FAQ on controversial new law to end "surprise billing" In September 2016, Governor Jerry Brown signed into law a controversial bill (AB 72) that will change the billing practices of non-participating physicians providing non-emergency care at in-network hospitals, ambulatory surgery centers and laboratories. While the enactment of AB 72 can never be described as favorable, the end result is a law that puts to rest the issue of so-called “surprise billing” in a way that preserves the ability of physicians to continue collecting their usual rate (as long as they obtain the consent of the patient), implements a statutory ... October 14, 2016 General, Managed Care Network Adequacy, Out of Network Care, Provider Networks 0 0 Comment Read More »
Will your practice be ready to comply with the requirements under new provider directory accuracy law? On July 1, 2016, a new law will take effect that requires plans to ensure that physician directories are accurate and up-to-date. The law (SB 137) includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payors' networks. Plans and insurers will be required to have certain data fields in the directory including, but not limited to, provider name, specialty, board certification (if any), practice address, city, zip, license number, NPI, whether the provider is accepting new patients, the product ... April 14, 2016 General Payor Contracting, Provider Directories, Provider Networks, Network Adequacy 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 »
New law requiring accurate provider directories includes provider obligation to update information On July 1, 2016, a new law will take effect that requires plans and insurers to comply with uniform standards, and provide timely updates, for their provider directories. The law (SB 137) includes multiple components aimed at providing patients with more accurate and complete information to identify which providers are in their payor’s network. Specifically, the law requires: Plans/insurers must offer an online provider directory available to the public, including physicians, without any restrictions or limitations. ... December 7, 2015 Managed Care Network Adequacy, Payor Contracting, Provider Networks, Commercial Payors 0 0 Comment Read More »
CMA continues to monitor health plan network directory accuracy Last November, the California Department of Managed Health Care (DMHC) released the results of an audit of the Anthem Blue Cross and Blue Shield Covered California networks. Among other things, the audit found that 12.8 percent of the physicians listed on Anthem’s network were not accepting Covered California patients, while 12.5 percent were not in practice at the location listed in Anthem’s directory. In the case of Blue Shield, only 56.7 percent of the physicians listed in Blue Shield's Covered California directory could be verified as accepting Covered California patients. ... August 17, 2015 Managed Care Blue Shield, Covered California, Network Adequacy, Anthem Blue Cross 0 0 Comment Read More »
California State Auditor releases report outlining flaws with Medi-Cal program The California State Auditor’s office released a report on Tuesday expressing a need for better monitoring of the health plans participating in California’s Medicaid program, Medi-Cal, in order to improve beneficiaries’ access to care. Among the key findings of the audit was that the California Department of Health Care Services (DHCS), which administers Medi-Cal, “has not consistently monitored health plans to ensure that they meet beneficiaries’ medical needs—it did not perform any annual medical audits before 2012 and performed medical audits on less than half of the health plans in ... June 26, 2015 Medi-Cal DHCS, Medi-Cal, Network Adequacy, Provider Networks, Department of Health Care Services 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 »
'Patient choice' bill goes down to defeat in the Assembly The California Medical Association (CMA) has defeated a bill that would have imposed unfair contracting conditions on physicians and exacerbated the state's current network adequacy concerns. The bill (AB 2533) would have required health insurers to arrange for, or assist in arranging for, out-of-network care for enrollees who are unable to obtain medically necessary care or services from a network provider, at no additional cost to the patient. Unfortunately, vague language in the bill could have been interpreted to require out-of-network providers to accept the contract reimbursement rates of ... September 5, 2014 General Advocacy, Payor Contracting, Network Adequacy 0 0 Comment Read More »
