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Has a contracted payor stopped paying claims?

August 04, 2017
Area(s) of Interest: Payor Issues and Reimbursement Practice Management 


The California Medical Association (CMA) has recently received an increased number of calls from physicians reporting concerns that some of the entities with whom they contract may have run into financial difficulties.

One of the symptoms of an insolvent health plan, IPA or other payor is the failure to pay claims in a timely manner. Another indication of financial distress is a payor that cuts checks within the statutory timeframes, but does not release the checks in a timely manner.

If you are experiencing repeated payment delays, you should investigate the financial health of the payor. To help physicians monitor the financial health of their contracted payors, CMA has put together a Payor Solvency Checklist. The checklist, available free to members in the CMA Resource Library, includes instructions on how to research and monitor the financial solvency of your contracted medical groups/IPAs, and discusses options available to physicians in the event a payor stops paying claims.

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