UnitedHealth delays changes to prior authorization process
Posted 4-3-12
As previously reported, United Healthcare had announced they would be expanding the list of services requiring prior notification as well as begin the transition of select services from prior notification to a prior authorization requirement effective April 1, 2012.
However, CMA has learned that United has delayed implementation of the prior authorization changes in California pending approval from the California Department of Insurance....
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Aetna Fee Schedule changes to take effect April 1
Posted 4-3-12
CMA recently learned of changes to the Aetna Market Fee Schedule (AMFS) that will take effect April 1, 2011 for commercial lines of business in Northern California.
In a December letter, Aetna informed physicians that it would be modifying physician reimbursement rates based on the service location zip code of the rendering physician....
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Department of Defense awards Tricare contract
to United Healthcare
On March 16, the Department of Defense announced they had awarded a $20. 5 billion contract to United Healthcare....
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Court awards payments in UHC class action lawsuit
February 13, 2012
A federal court judge has cleared the way for nearly $200 million in awards to be disbursed to physicians through a settlement against UnitedHealth Group. This disbursement would settle claims from physicians for 15 years of artificially low payments the insurer paid for out-of-network health services....
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Blue Cross Announces Contract Changes
Posted 2-7-12
In December, Anthem Blue Cross notified its contracting physicians of impending changes to its Prudent Buyer Participating Physician Agreement, which will become effective April 1. The amendment includes an expanded confidentiality provision and several modifications to Exhibit F, which pertains to the Blue Cross Medicare Advantage PPO product....
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Blue Shield Launches Re-Contracting Initiative
Posted 1-24-12
The California Medical Association (CMA) has learned that Blue Shield is in the process of re-contracting with physicians across the state. Notices to physicians are scheduled to be mailed on January 27....
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Blue Cross Required to Pay Providers
Posted 1-18-12
On January 12, the California Department of Managed Health Care (DMHC) ordered Anthem Blue Cross to pay health care providers money owed to them, with interest, for services provided dating back to 2007. The action is a result of Anthem’s refusal to remediate providers following a financial claims audit that identified errors in payment of medical claims....
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Plans to Recoup Provider Payments For Medi-Cal
Posted 12-14-11
On December 2, 2011, the Department of Health Care Services (DHCS) announced it intends to recoup a 10 percent reduction in Medi-Cal provider payments retroactive to June 1, 2011, as part of the California Budget Act of 2011. The California Medical Assoication (CMA) met with DHCS immediately afer its announcement in an effort to understand how this news will impact physicians....
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Cigna reduces claim filing time limit to 90 days
Posted 10-18-11
On November 1, 2011, Cigna will change the claim filing time limit for contracted providers from 180 days to 90 days. Those impacted will be notified in writing of any changes and will receive an amendment to their agreement, or will be contacted by a Cigna representative.
- When Cigna is the primary insurance, claims must be received within 90 days of the date of service.
- When Cigna is secondary, claims must be received within 90 days of receipt of the Explanation of Payment from the primary payor.
The change also applies to health care professionals whose Cigna contract includes GWH-Cigna business.
Sorting through THREE different types of “audit”
LETTERS FROM BLUE CROSS
Posted 7-25-11
Physicians are currently receiving three different audit letters from Anthem Blue Cross. This article summarizes the three audits in question and will help physicians understand the issues in play....
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Operating Engineers
fails to pay claims in a timely fashion
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Blue Cross Special Investigations Unit
CMA asks DMHC to Investigate Improper Refund Requests
7-6-11 (Sign in)
The California Medical Association (CMA) has received complaints from physicians who have received refund requests from the Anthem Blue Cross Special Investigations Unit that were outside of the 365-day period allowed by California law. As a result, CMA has filed a formal complaint with the Department of Managed Health Care (DMHC) and asked them to quickly investigate these potential violations....
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Payer Updates
Posted 7-8-11
United Healthcare recently announced that the PacifiCare name and logo will no longer be used as of June 30, 2011. PacifiCare HMO is now known as UnitedHealthcare Signature Value/United Healthcare WEST....
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Blue Cross fee schedule changes take effect Sept. 1
Posted 6-7-11
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