CMA <strong>NEWS</strong> Defense Health Agency issues temporary waiver for TRICARE authorizations and referrals Since the transition of TRICARE managed care services from United Health Military & Veterans (UMVS) to Health Net Federal Services (HNFS) on January 1, 2018, physicians have reported significant delays 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 Anthem agrees to fully rescind modifier 25 policy This past fall, Anthem Blue Cross notified physicians in several states that effective January 1, 2018, it would reduce reimbursement of evaluation and management (E&M) services billed with 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 CMA publishes guide for physicians affected by EHS contract terminations On December 26, 2017, DMHC issued a cease-and-desist order, requiring nine health plans to terminate their contracts with Employee Health Systems Medical Group Inc. 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 DMHC proposes "average contracted rate" metholology The California Department of Managed Health Care (DMHC) has issued proposed regulations for calculating payors&rsquo; &ldquo;average contracted rate&rdquo; under California&rsquo;s new out-of-network billing 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 CMA files brief in important peer review case CMA has filed an amicus brief in support of two neonatologists who lost their privileges at Pomona Valley Hospital Medical Center. The physicians initially prevailed after a protracted peer reviewing hearing that spanned 38-months, before a peer review panel of seven specialists. 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 CMS launches new MIPS reporting tool Deadlines are fast approaching if you plan to submit 2017 data for Medicare&rsquo;s&nbsp;Merit-based Incentive Payment System (MIPS). Don&rsquo;t wait until the last minute to submit your data.&nbsp;The 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 Anthem rescinds Nivano termination for Medi-Cal managed care As previously reported, Anthem Blue Cross had initiated the termination of its relationship with delegated entity, Nivano Physicians Medical Group, for its HMO and Medi-Cal managed care products. However, 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 California Medical Association applauds CDI and DMHC probe into Aetnas practice of denying medically necessary care This week, the California Department of Insurance (CDI) and the Department of Managed Health Care (DMHC) announced an investigation into Aetna Inc.s coverage denials that appear to put profits before patients. The investigations were launched, in part, after a former Aetna medical director admitted he never looked at patients records when deciding whether to approve or deny health care. Denying coverage without a physician ever reviewing medical records is a potential violation of law. 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 CMA Docs: Shannon Udovic-Constant, M.D., and James Constant, M.D. "If you spend everything on work there is nothing left to give to yourself and the meaningful relationships that are truly the most important thing for lifelong happiness. 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 TRICARE program officially transitioned to Health Net Federal Services On January 1, 2018, Health Net Federal Services (HNFS) began providing managed care services to 2.9 million TRICARE beneficiaries in the 21 western states, including California. During the first month 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 Noridian implements temporary ICD-10 code fix for mammography and breast biopsy policies California's Medicare contractor, Noridian, recently implemented a temporary correction to the National Coverage Determination policies for mammograms (NCD 220.4) and percutaneous image-guided 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 Next round of Medi-Cal ACA primary care rate adjustments forthcoming The California Department of Health Care Service (DHCS) recently announced that the final round of retroactive interim payment corrections, tied to the primary care physician (PCP) rate increases called 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 UnitedHealthcare to implement stricter notification requirements for out-of-network laboratory referrals UnitedHealthcare (UHC) announced in its January 2018 Network Bulletin that it will begin enforcing stricter notification requirements related to out-of-network laboratory referrals. According to the 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 County Medical Services loan repayment program now accepting applications The California State Loan Repayment Program (SLRP) application cycle for 2018 is now open. The program assists with the repayment of educational loans for health care professionals who work in underserved 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00 Future CMA Doc: Kayla Sheehan Second year medical student, Kayla Sheehan, was recently awarded the 2017 Medical Student Scholarship from the Sierra Sacramento Valley Medical Society (SSVMS) for her academic accomplishments. Name: Kayla Sheehan Specialty: Medical Student City: Sacramento Member Since: 2016 Second 0001-01-01 00:00 +00:00 0001-01-01 00:00 -08:00