Anthem software upgrade caused widespread claims payment errors in March

April 05, 2017
Area(s) of Interest: Practice Management 

Health Net recently issued a notice to all California participating physician groups advising that monthly updates of provider demographic changes would be required as part of its initiative to comply with Senate Bill 137.

The California Medical Association (CMA) inquired further with Health Net regarding the frequency of the updates. Health Net clarified that the notice was only intended for its delegated groups. CMA has asked whether a correction notice has or will go out to affected physicians, and is waiting to hear back from Health Net

SB 137, the provider directory accuracy law, requires physicians to respond payor notifications regarding the accuracy of their provider directory information, either by confirming the information is correct or by updating demographic information as appropriate. Plans are required to make outreach to physicians at least annually for groups and at least every six months for individual providers. Failure to respond to the requests may result in a delay in payment and removal from the payor’s provider directory. Additionally, a payor may terminate a contract with a provider for a pattern or repeated failure to update the required information in the directories.

To help physicians understand the new law, and what they need to do to avoid penalties, CMA published a toolkit: “What Physicians Need to Know to Avoid Penalties Under the New Provider Directory Accuracy Law.” The toolkit is available FREE for CMA members on our website.


Was this article helpful?    
Download the New CMADocs app!

Download the new CMADocs app!

CMA's new mobile app lets you connect with your colleagues and engage with CMA content!  Download the "CMADocs" app today from the Apple or Google Play app stores for daily news updates, events calendar, resource library and more.

Latest News

Load More