December 14, 2017
Area(s) of Interest: Payor Contracting Payor Issues and Reimbursement
The California Medical Association (CMA) has learned that Anthem Blue Cross is in the process of terminating its relationship with Nivano Physicians Medical Group for its HMO and Medi-Cal managed care products. Anthem is transferring enrollees from Nivano to alternative networks. The termination by Anthem follows on the heels of Blue Shield of California and UnitedHealthcare (UHC) contract terminations with Nivano earlier this year.
Nivano, also known as Northern California Physicians Medical Group, with enrollees in Placer, Nevada, Sacramento, Yuba and Colusa counties, is currently on a corrective action plan with the Department of Managed Health Care (DMHC) for failure to meet financial solvency criteria.
Anthem has advised that, effective November 30, 2017, approximately 3,400 commercial HMO enrollees were reassigned from Nivano to alternative medical groups in the area, with approximately 2,000 enrollees transitioning to Hill Physicians Medical Group.
Additionally, Anthem filed a block transfer request with DMHC on September 26, requesting approval to transfer its approximately 42,000 Medi-Cal covered lives from Nivano effective January 31, 2018, with River City Medical Group and Employment Health System (EHS) receiving approximately 2,000 of those enrollees.
As CMA previously reported, Blue Shield terminated its contract with Nivano effective August 10, 2017, transferring 2,707 patients to alternative provider groups. UHC terminated its relationship with Nivano and reassigned its 1,750 patients effective August 1, 2017.
Practices experiencing problems with Nivano or issues resulting from the plan terminations are encouraged to contact CMA’s Reimbursement Helpline at (888) 401-5911 or email@example.com.