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Physicians encouraged to familiarize themselves with exchange plan changes heading into Covered California open enrollment



November 14, 2014

Covered California began enrollment for its second year on November 15 and exchange officials are predicting a 45 percent jump in enrollment, from 1.2 million in 2014 to 1.7 million in 2015. Last year, open enrollment was a six-month process, this year it will be half as long, starting Nov. 15 and ending Feb. 15.


In anticipation of this year's open enrollment, some payors have updated their exchange plan offerings for 2015, including plan types and plan names. The California Medical Association (CMA) will be publishing details of these changes as they are announced. See the most current exchange-related news and updates.


Physicians are encouraged to familiarize themselves with the changes and to verify their exchange plan participation status on the plans' websites. When searching the provider directories, it’s important to select the correct exchange product type, as Anthem Blue Cross and Blue Shield of California are utilizing significantly narrowed networks for their exchange products. Health Net has also announced changes to their product types that will utilize new provider networks, so it’s extremely important practices re-verify their participation status in exchange/mirror products for 2015.


It is also imperative that front office staff have a clear understanding of their physicians’ participation status. With some plans utilizing narrowed networks, it is no longer satisfactory to simply accept “I have Blue Shield” as an indication of whether the patient can be seen in-network. It is important, when scheduling, to determine in advance if the physician is indeed in the patient’s network.


For more information, CMA members can access our tool titled, see "Covered California: Know Your Participation Status."

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