October 09, 2018
Area(s) of Interest: Commercial Payors Practice Management
The California Medical Association (CMA) has confirmed that Inland Empire Health Plan (IEHP) completed its contract termination with Vantage on August 31, 2018.
IEHP transitioned its 273,000 covered lives to the following delegated groups:
|Receiving Provider Group
||Number of Enrollees
|Alpha Care Medical Group
|La Salle Medical Associates
|Inland Faculty Medical Group
|Regal Medical Group
|Physician Health Network
|Horizon Valley Medical Group
According to IEHP, 99.4 percent of enrollees retained the same primary care physicians.
The plan’s block transfer filing indicated that the termination was the result of conduct by Vantage that resulted in the inappropriate delay, denial or modification of authorizations for services and care provide to IEHP’s Medi-Cal managed care enrollees. According to IEHP, Vantage had, over a period of years, engaged in conduct that violates state and federal laws regarding the prompt and timely payment of provider claims, includes manipulating and falsifying claims, banking records and audit reports.
Blue Shield of California, Blue Shield of California Promise Health Plan (formerly Care1st) and Molina had also issued notices of their intent to terminate if Vantage failed to correct the breaches, but have extended their termination dates to November 30, 2018.
Practices experiencing any payment issues for Vantage claims for services on or before the IEHP termination date are encouraged to contact CMA’s Reimbursement Helpline at (888) 401-5911 or firstname.lastname@example.org.