UHC Releases Latest Premium Designation Physician Results In late July UnitedHealthcare (UHC) released its latest rankings of physicians within 16 specialty categories on both national and specialty-specific quality and cost-efficiency benchmarks. August 6, 2018 General Care, Managed Read More »
Medi-Cal Managed Care Providers Are Required to Enroll All contracted physicians in a Medi-Cal managed care network must enroll in the Medi-Cal program by December 31, 2018. July 16, 2018 General Care, Managed Read More »
UHC Reimbursement for After-Hours and Weekend Care Effective August 18, 2018, UnitedHealthcare (UHC) will allow reimbursement for CPT code 99051 (services provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service) when billed with acute care services by a primary care physician (PCP). July 13, 2018 General Care, Managed Read More »
SB 538 Withdrawn SB 538, a bill that would have prohibited large health systems from requiring health insurers to contract with all their hospitals and affiliates, has been withdrawn. July 6, 2018 General Care, Managed Read More »
Anthem Required to Publish Effective Dates for Clinical Policies The Department of Managed Health Care (DMHC) is requiring Anthem Blue Cross to publish effective dates for their medical and clinical utilization management policies, and to clearly indicate whether a policy applies in California, as the result of a California Medical Association (CMA) inquiry in March. June 27, 2018 General Care, Managed Read More »
Ask Assemblymembers to Oppose AB 3087 On Wednesday, May 16, the Assembly Appropriations Committee will be considering AB 3087 (Kalra), which would create a commission of unelected political appointees empowered to arbitrarily cap rates for all health care services in all clinics, hospitals, and physician practices in California. May 15, 2018 General Care, Managed Read More »
Health Net Delays Modifier 25 Change Health Net is delaying its proposed reduction in modifier 25 and emergency services payments for its Medicare and Medi-Cal lines of business until July 1, 2018. May 7, 2018 General Care, Managed Read More »
Aetna to Terminate Physician Payments by Check Aetna informed contracted physicians on February 1 that the option of receiving payment by check will no longer be available and is asking providers to choose either electric funds transfer (EFT) or virtual credit card (VCC). May 7, 2018 General Care, Managed Read More »
Prior Authorizations Negatively Affect Patient Outcomes A recent American Medical Association (AMA) survey of 1,000 practicing physicians found that payers' prior authorization requirements delay treatment, have a negative impact on clinical outcomes, and lead patients to abandon treatment. May 7, 2018 General Care, Managed Read More »