Exchange Resources
Under the Affordable Care Act, millions of Californians are now covered by private insurance through Covered California, a health insurance exchange purchasing pool. CMA has developed several resources to help educate physicians on the exchange and ensure that they are aware of important issues related to exchange plan contracting. Visit www.cmanet.org/exchange.
Practice Empowerment Resources Most resources listed below can be located on our website at www.cmanet.org/ces.
MEMBER BENEFITS & SERVICES
Payor Profiles CMA has compiled critical information for interacting with the major payors. On each of the payor profiles you will find important contact numbers, addresses and links for quick reference for payor interactions. These documents are updated annually. Contract Renegotiations: Making Your Business Case When submitting a request to open up a contract renegotiation discussion, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. Learn how to prevent the “auto-reply” and be thoughtful in renegotiation requests. Directory Accuracy Law On July 1, 2016, a new law took effect that requires plans to ensure that their physician directories are accurate and upto-date. CMA has published a guide to help physicians understand the new provider directory accuracy law, and what they need to do to avoid penalties. Get more info at www.cal.md/directory-accuracy. Contract Amendments: An Action Guide for Physicians This guide is designed to help physicians understand their rights and options when a health plan notifies them of a material modification to a contract, manual, policy or procedure.
Managed Care Contracting CMA offers members free access to objective analyses of several health plan participating provider contracts. While these analyses are not intended to be exhaustive, they are designed to draw a physician’s attention to issues which may warrant further inquiry or clarification. Surviving Covered California Tip Sheets CMA has compiled critical information to help physicians understand their participation status, which products are being offered, which provider networks those products are associated with, how to navigate the federal grace period and how to survive Covered California, in general. Covered California FAQs With the launch of California’s health benefit exchange, Covered California, millions of Californians are now eligible to purchase insurance through this new online marketplace. Understandably, patients and providers have many questions. CMA has created two FAQs – one designed to provide answers to the most common patient questions and one addressing provider questions. Covered California: Understanding the Grace Period for Subsidized Enrollees Federal law allows Covered California enrollees who receive financial subsidies to keep their health insurance for three months, even if they have stopped paying their premiums. This is known as the “grace period.” This document contains answers to frequently asked questions such as how practices can identify patients in the grace period, what their options are if a patient presents with suspended coverage, and how to identify whether the patient or the plan is responsible for paying a claim for a patient in the grace period. Covered California: Know Your Participation Status Unfortunately, checking your practice’s participation status is not as straightforward as it might seem. Some exchange plans use vague contract terms and amendments that rope physicians into
CMA: Tools and Resources to Empower Physician Practices
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