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    CMA publishes Prop 56 payment monitoring worksheet

    November 07, 2018
    To help physician practices monitor their Prop 56 supplemental payments, the California Medical Association (CMA) has p...

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    Coding Corner: Separate reporting of pre-, intra- and post-procedure work

    October 30, 2018
    “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. Thi...

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    First-ever TRICARE open enrollment begins November 12

    October 18, 2018
    Beginning November 12 and running through December 10, 2018, TRICARE will initiate its first ever open enrollment perio...

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    L.A. Care partially rescinds recoupment requests

    October 18, 2018
    Between June and August of this year, L.A. Care issued a large number of overpayment requests to physicians. According...

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    IEHP completes termination of Vantage contract; three plans extend termination dates

    October 09, 2018
    The California Medical Association (CMA) has confirmed that Inland Empire Health Plan (IEHP) completed its contract ter...

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    Deadline to request a review of MIPS score is October 15

    October 01, 2018
    The Centers for Medicare and Medicaid Services (CMS) recently released 2017 Merit-based Incentive Payment System (MIPS)...

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    Noridian announces improvements to Medicare portal

    September 28, 2018
    Noridian, the Medicare Administrative Contractor for California, recently announced improvements to the Noridian Medic...

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    DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019

    September 20, 2018
    The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Med...

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    Have you received your supplemental Medi-Cal managed care payments?

    September 20, 2018
    Plans were required to issue supplemental payments to qualifying physicians within 90 days. The 90-day window ended Aug...

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    CMS identifies and corrects errors in MIPS scoring logic

    September 14, 2018
    The Centers for Medicare and Medicaid Services recently released 2017 Merit-based Incentive Payment System performance ...

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    CalHIPSO Webinar: MIPS Reporting for 2018

    September 14, 2018
    The Health Services Advisory Group and the California Health Information Partnership & Services Organization (CalHIPSO)...

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    Coding Corner: ICD-10 unveils new diagnostic codes to report human trafficking

    September 11, 2018
    CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billin...

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    Health Net addresses problems with explanation of payment

    September 11, 2018
    On August 21, 2018, Health Net notified providers that some paper explanation of payment (EOPs), commonly known as expl...

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    UnitedHealthcare to discontinue use of fax numbers for medical prior authorization requests

    September 11, 2018
    UnitedHealthcare announced in its September 2018 Network Bulletin that it will begin retiring fax numbers utilized for ...

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    L.A. Care issues recoupment letters for services dating back to 2012

    September 11, 2018
    CMA has learned that L.A. Care Health Plan, the publicly operated Medi-Cal health plan serving more than 2 million Los ...

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    Health Net Federal Services continues to address TRICARE transition issues

    September 10, 2018
    As previously reported, Health Net Federal Services (HNFS) has experienced implementation issues since taking over as t...

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    Health information exchange and CURES: What physicians need to know

    September 10, 2018
    This spring, a coalition led by CM) and CalHIPSO secured a $5 million expenditure for health information exchange (HIE)...

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    Medi-Cal to unveil updated provider enrollment system this summer

    August 10, 2018
    The California Department of Health Care Services (DHCS) is will soon be releasing an update to its Medi-Cal provider e...

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    UnitedHealthcare Community Plan to exit Sacramento Medi-Cal market on November 1

    August 10, 2018
    The UHC Community Plan has issued notice that it will no longer provide services to approximately 4,400 Medi-Cal member...

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    Coding Corner: NCCI Policy Manual updates: Part 2

    August 03, 2018
    CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billin...

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    Noridian to present in-person Medicare seminars in Irvine and Sacramento

    August 03, 2018
    Noridian, the Medicare administrative contractor for California, has announced several in-person seminars around the st...

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    UnitedHealthcare releases latest Premium Designation physician results

    August 03, 2018
    UnitedHealthcare (UHC) recently released its latest Premium Designation assessment results to California physicians on ...

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    United Healthcare Smart Edits go live August 16

    August 03, 2018
    UnitedHealthcare (UHC) will implement its Smart Edits program for professional claims for all of its commercial, Medica...

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    Best practices: Review your monthly capitation reports

    August 03, 2018
    Participation in capitated reimbursement contracts (financial arrangements where physicians are paid a fixed amount for...

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    Health Net Federal Services experiences significant challenges with TRICARE transition

    July 24, 2018
    On January 1, 2018, Health Net Federal Services (HNFS) became the new Defense Heath Agency (DHA) managed care contractor...

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    2017 MIPS scores and 2019 payment adjustments now available

    July 20, 2018
    Physicians can now log in to the Medicare Quality Payment Program (QPP) website to view their final 2017 Merit-based ...

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    DHCS requires enrollment for all Medi-Cal managed care providers

    July 06, 2018
    In January 2018, the California Department of Health Care Services (DHCS) began requiring that all Medi-Cal managed c...

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