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Medi-Cal Managed Care Quality Improvement Reports (CA)
Various reports from the State of California regarding the quality of care provided by Medi-Cal managed care health plans. Plan-specific evaluation reports are also prepared for each individual health plan reviewed.
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Eligibility: Contract Language (Payer v Provider) and Sample to Use
Eligibility: Contract Language (Payer v Provider) and Sample to Use.
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Toolkit Managed Care Resource
The Managed Care Legal Database is a resource identifying how state and federal statutes and regulations address many issues that may occur between private payers and physicians, such as prior authorization, credentialing, network adequacy, out-of-network payment, and contract termination. The Database also contains relevant AMA policy, issue briefs, advocacy resources, model legislation, and a State…
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NEW RULES:Bans on balance billing and out-of-network cost-sharing
Effective Jan. 1, 2022, Health Plan commercial members will be protected from balance billing after receiving emergency care and nonemergency care from certain out-of-network providers at in-network facilities. The No Surprises Act, which is included within the Consolidated Appropriations Act of 2021 (the CAA), provides the following:
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Managed Care Contracts and Health System Operational Alignment
CASE EXAMPLE of how we breakdown contracts and tie the terms to operational alignment Because the business of healthcare is to deliver the highest quality care to patients, improving clinical performance is the driving focus. However, understanding and responding to financial pressures through increased efficiency and enhanced revenue capture is what makes high-quality clinical delivery…
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Payer Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage
Carenodes Health Enterprise Office of the Executive Dear Health Plan Representative, Please see attached Notice regarding the implementation of Senate Bill 855, Mental Health and Substance Use Disorder Coverage.
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Expert Seminar on Parity Laws and Reimbursement
Learn to speak the Managed Care Language (101)
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Payer Contract Modeling
Contract modeling, or analyzing potential scenarios of reimbursements to understand financial outcomes, provides a proactive approach to financial management by analyzing the impact of different elements such as methodologies, rate changes, pricing, payor mix shifts and ever changing regulations on margins, rather than net revenue alone.
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Healthcare Flow of Funds explained: Healthcare Entrepreneur Bootcamp
Agenda Managed Care 101 for healthcare entrepreneurs seeking to do business in the California market.
Alex Yarijanian, entrepreneurs, Funding, Managed Care, Managed Care 101, Medi-Cal) Duals (Medicare and Medicaid beneficiaries) Commercial (on exchange, Medicare (Traditional Medicare and Medicare Advantage, off exchange) California, Parts ABCD) Medicaid (managed Medicaid, Payers, Reimbursement structures (payer/provider agreements), Startups, state / federal
