Private Payer News Archive
Please select the links below for complete Private Payer articles and events of past years. View Current Private Payer News
12.11.09 UnitedHealth Premium Designation program update
Read news article
Click here for UHC announcement
12.07.09 Aetna: Mammograms, cervical cancer screening coverage unchanged
Aetna says that its coverage policies for mammograms and cervical cancer screenings remain unchanged. The company says that Aetna covers...
- Annual screening mammograms for women beginning at age 40, and for women younger than age 40 who have a family history or genetic risk factors that place them at a heightened risk for breast cancer.
- Annual cervical cancer screenings with no age restrictions.
Click here for Aetna's Clinical Policy Bulletins
12.03.09 Settlement in AMA lawsuit against UnitedHealth Group gets preliminary approval from federal court
Read AMA's press release
12.02.09 AMA comparison of three physician profiling programs
The AMA has created 'A Comparison of Three Physician Profiling Programs' to provide physicians with up-to-date information on the physician profiling programs sponsored by Aetna, Cigna and UnitedHealthcare. Additionally, the chart provides a straight-forward tool to analyze these programs on key elements that are common to programs that measure physician performance on quality and cost of care standards.
View AMA's chart
11.30.09 UnitedHealthcare will continue to offer coverage of screenings for women under 50
Read UHC's memo
11.17.09 UHC changing radiology notification program
UnitedHealthcare has changed its radiology notification program and will require premium quality and cost efficiency (Q&E)-designated physicians to submit prior notification for advanced imaging services effective February 15, 2010.
Read UHC notice to physicians
View frequently-asked-questions
View UHC outpatient radiology notification protocol
View radiology notification with evidence-based dialogue quick reference guide
11.16.09 AMA alerts address unfair payer practices
The AMA has introduced a free resource that addresses unfair payer practices and which offers a variety of other practice management resources and tools.
Read more
Click here to sign up for AMA’s "Practice Management Alerts"
10.28.09 AMA posts new resources for "Heal the Claims Process" month
The American Medical Association (AMA) has new online materials for its “Heal the Claims Process” month. Physician practices often experience an increase in underpayments and denials during the last quarter of the year, so November is an ideal time to appeal inappropriately underpaid or denied claims. Instead of accepting increased claims underpayments and denials, physician practices can appeal these claims and collect their appropriate payment in January and February.
Click here for more information
08.11.09 UnitedHealthcare, Saint Joseph's sign new contract
The Atlanta Journal-Constitution has reported that UnitedHealthcare and Saint Joseph’s Health System signed a new contract. The report says the deal ensures that UnitedHealthcare members get in-network services from St. Joseph’s hospitals and doctors. The previous four-year UnitedHealthcare contract did not cover procedures such as outpatient implants and invasive robotics procedures, which St. Joseph’s asked for this time, according to the AJC. Contract negotiations had reportedly stalled for a number of weeks mainly due to a reimbursement increase.
07.30.09 UnitedHealthcare addresses Saint Joseph's contract termination
UnitedHealthcare submitted the following statement to MAG...
"UnitedHealthcare regrets the disruption that will result from Saint Joseph's termination of its contract with UnitedHealthcare as of August 8, 2009. UnitedHealthcare respects Saint Joseph's and all that it means to the residents of Atlanta. We regret that it was not possible to arrive at a contract which permits a continuing relationship between UnitedHealthcare and Saint Joseph's. UnitedHealthcare has a very strong network of Atlanta-area hospitals that are conveniently located for its customers who might be impacted by Saint Joseph's termination. The network includes among others Emory University Hospital, Emory University Hospital-Midtown, Northside Hospital, Piedmont Hospital, Atlanta Medical Center, Grady Hospital and Dekalb Medical Center. The many high quality in-network hospitals that are available to UnitedHealthcare customers provide access to a vast array of primary, secondary and tertiary services. UnitedHealthcare will work closely with patients and their physicians on a Transition of Care plan to ensure continuity of care for members receiving ongoing medical treatment at Saint Joseph's. Members with pre-planned services through Saint Joseph's may be eligible for network benefits for these services during a transition period. Members should call the customer care number listed on their ID cards to determine eligibility."
07.22.09 AMA's health insurer report card for 2009 now online
The American Medical Association (AMA) posted its National Health Insurer Report Card for 2009 at www.ama-assn.org/go/reportcard. The Web site hosts a one-hour webcast on the "Heal the Claims Process" campaign, the report card, and a claims management revenue cycle check-up for physicians. AMA has also posted new information about its administrative simplification activities at www.ama-assn.org/go/simplify.
05.19.09 Compliance process in BCBS settlement in effect; Make sure you are being paid correctly
The class action lawsuits brought by several state and county medical societies and physicians against the for-profit health insurers resulted in settlements which required the health insurers to significantly change the way they conduct business. The Physicians' Advocacy Institute (PAI) is charged with enforcing the settlements on behalf of physicians. Currently all the provisions in the Blue Cross Blue Shield Settlement Agreement have taken effect. PAI is offering a Webinar on the topic on Wednesday, June 10.
Read PAI article for more details
Download BCBS dispute form
Click here for information on PAI Webinars on topic
05.11.09 New resource to help physicians get paid in timely, accurate way
The Physicians Advocacy Institute's (PAI) Health Claims Data Warehouse is introducing an innovative online tool that will enable physicians to confirm the accuracy of their claims payments in a simple and automated way. PAI's MDEdge will provide detailed information about the claims that physicians submit to health insurers, according to Project Manager David Ginsberg.
PAI is currently preparing for the system's testing phase, Ginsberg says. He confirms that this includes a number of Medical Association of Georgia (MAG) member practices. Ginsberg says he expects MDEdge to be rolled out in full in January 2010. And while a subscription fee has not yet been fixed, he says PAI's plan is to keep the cost affordable for physicians.
Read full news article
Frequently Asked Questions on Health Claims Data Warehouse
04.22.09 CIGNA reducing number of CPT modifier 25 and 59 code pairs
The American Medical Association (AMA) has reported that CIGNA says it will significantly reduce the number of code pairs for procedures and services that are appended with a CPT modifier 25 or 59 beginning April 27. AMA says that CIGNA is making the change given the concerns that were expressed by a number of medical groups over the policy requiring increased documentation.
Read full news article
03.30.09 UnitedHealth Premium designations to be posted April 1
The UnitedHealth Premium designations will be posted on the web portal Wednesday, April 1. This posting and designation effective date will affect those who have changes to their quality and efficiency (Q&E) designation that order and perform advanced imaging services.
UnitedHealthcare exempts physicians with Q&E designations from the Radiology Notification Program requirements that apply to certain outpatient imaging procedures (CT scans, MRIs, MRAs, PET scans, and nuclear medicine studies, including nuclear cardiology). Newly Q&E designated physicians will now be exempt for the requirements while those who do not have the Q&E designation must now comply with the notification protocol. Note: the exemption applies to individual physicians only and not to a group practice.
View letter to providers
UnitedHealth's guide on radiology notification program
UnitedHealth's frequently-asked questions on radiology notification program
03.16.09 UnitedHealthcare announces changes to its physician designation program for oncology
UnitedHealthcare has made changes to the UnitedHealth Premium® physician designation program for oncology. In the past, oncologists were invited to participate in our program by completing a survey about important clinical characteristics regarding their individual practice. Those who submitted a survey response and met the program requirements were recognized in our online Web sites with the Quality designation. We appreciate all oncologists who participated in our program.
The UnitedHealthcare Premium designation program, which has evaluated physicians in 21 different specialties, continues to evolve based upon the input of practicing physicians and medical specialty societies. As a result of their input, UnitedHealthcare has decided to discontinue the current, survey-based approach to Premium designation for oncology. All of our contracted oncologists will receive a letter this week notifying them of the change in our program. What this means for oncologists:
- This spring, our online directories will display “Specialty Not Evaluated” next to the name of network oncologists. This is how we currently display the names of other physicians who are in specialties that are not evaluated in the Premium designation program.
- We will continue to work with oncologists and their specialty organizations to develop useful performance assessment programs. For example, in the future, we will recognize physicians on our consumer Web sites, for their participation in the American Society of Clinical Oncology’s Quality Oncology Practice Initiative® program.
- We are also testing a set of measures for oncology quality and cost efficiency based on national standards from specialty societies and the National Comprehensive Cancer Network. Only after these measures are validated, will they be used in future releases of the UnitedHealth Premium designation program for oncology.
- Because we are discontinuing our current program, we are no longer accepting new surveys from oncologists.