Practices reporting challenges with Nivano

June 29, 2017
Area(s) of Interest: Payor Issues and Reimbursement 

Over the past few weeks, the California Medical Association (CMA) has received a surge in complaints about Nivano Physicians Inc. Practices have reported problems with delays in authorizations and unpaid claims, and have also raised concerns that Nivano made a material change to their contracts without providing the 45-business days advanced notice required under California law.

Nivano, also known as Northern California Physicians Medical Group and Sierra Nevada Medical Associates, with enrollees in Placer, Nevada, Sacramento, Yuba and Colusa counties, is currently on a corrective action plan with the Department of Managed Health Care for failure to meet the financial solvency criteria between the fourth quarter of 2015 and the third quarter of 2016.

CMA made outreach to Nivano and was advised that the authorization issue had been resolved as of last week. Nivano is currently reviewing CMA’s concerns with the material change notice.

Practices that are experiencing problems with Nivano should contact CMA’s Reimbursement Helpline at (888) 401-5911 or economicservices@cmadocs.org.

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