News

Anthem has just recently announced that they’ve expanded their Priority Select HMO network into Ventura, San Luis Obispo, and Kern Counties effective 3/1/24. The following Medical Groups, site codes included, will now be part of our Priority Select HMO network. Dignity Health Medical Network (KFC) ; which now includes Valley Care under this site code. Hispanic Physicians IPA-Kern (Z0Z) . Bakersfield Family Medical Center (0EY) . Seaview IPA (0GN). Coastal Communities Physician Network (1BS) For More Information, Click Here For Help Quoting Anthem, Please Contact Your Dickerson Sales Rep Today!

Blue Shield has shared an update in regards to Providence St. Joseph Health System. Providence has issued a termination notice for medical group and facility contracts with Blue Shield of California. Unless an agreement is reached, our current contract with Providence will end May 31, 2024 . While Blue Shield has been negotiating, they must also prepare member communications as required, beginning April 1, 2024. For More Information, Click Here For More Information or Help Quoting Blue Shield, Please Contact Your Dickerson Sales Rep Today!

Covered California for Small Business (CCSB) has announced the launch of new enhancement features in the MyCCSB portal. These enhancements provide easier access to resources and streamline new book of business processes. These enhancements aim to empower brokers with the tools and resources they need to better serve their clients and navigate the complexities of the health insurance landscape. Subscriber IDs are now displayed on the Employee Dashboard and you can now export a complete employer census. These new updated portal features will save you time and easily provide members access to care, providing brokers with the ability to: View subscriber's carrier ID numbers on the Employee Dashboard. Export the Employee Census including carrier information For More Information, Click Here For Help Quoting CCSB, Please Contact Your Dickerson Sales Rep Today!

Updates to Quoting and Installation for Unlimited Annual Max WITH Implant Rider Quoting Effective immediately, if your broker’s client is requesting a dental plan with the Unlimited Annual Max WITH Implant Rider, the quote will require underwriting review for pricing adjustment. This option will still be available via New Case Account Manager but will be considered invalid, unless it has been submitted to Underwriting for review. Suggestions: Do not quote (or recommend) this combination unless specifically requested. If running quotes in-house, continue to do so, except for this combination. If the Unlimited Annual Max WITH Implant Rider is needed, submit a request to your sales rep and ezrate@humana.com for that option. If requesting the Unlimited Annual Max WITH Implants, you will have 2 quotes. One version with that option and another version with other requested options. Installation via Launch My Group (LMG) If the Unlimited Annual Max WITH Implants Rider is sold alongside other lines, the quotes will need to be updated to merge into one quote for LMG installation. For More Information or Help Quoting Humana, Please Contact Your Dickerson Sales Rep Today!

Reminder: RxDC Reporting Due June 1 With the 2023 reference year RxDC reporting deadline approaching soon, familiarize yourself with recent updates to the RxDC Reporting Instructions. As a reminder, the Consolidated Appropriations Act, 2021, includes a provision that requires group health plans and health insurance issuers (collectively “plans and issuers”) to report certain specified data related to prescription drug and other healthcare spending. The first RxDC report (for 2020 and 2021) was due on January 31, 2023, with the report for 2022 following soon thereafter on June 1, 2023. The deadline to submit reporting for calendar year 2023 is June 1, 2024 (and continues each June 1 thereafter). In anticipation of the June 1, 2024 deadline, the agencies updated the reporting instructions. The most relevant updates are summarized below: Sections 4.2, 8 and 9: For P2, Column C, the instructions clarify how a reporting entity that is submitting data for a carved-out benefit needs to populate the field. Additional detail on reporting information in the prior year columns in D5 and the restated rebate columns in D6, D7 and D8. Corresponding instructions clarify how to represent plans in P2 when the plan contributes to the prior year and restated fields but not to the current year fields (Sections 4.2, 8 and 9). Section 5.6: In prior year reporting, enforcement of the aggregation restrictions preventing data in files D1 and D3-8 from being aggregated at a less granular level than the aggregation level used by the reporting entity that submitted the data in D2 Spending by Category was suspended; however, this requirement will no longer be suspended for 2023 reference year reporting. Section 6.1: Plans may now use a simplified calculation of average monthly premium to use total annual premium divided by 12 in lieu of using the average monthly premium on a per-member basis. In addition, a simplified calculation of premium equivalents, which removes restrictions on reporting on a cash basis and using paid claims rather than incurred claims, may be used. The instructions also provide additional details about amounts that should be included or excluded from premium equivalents. Section 8.1: The instructions clarify that medical devices, nutritional supplements and over-the-counter drugs are excluded from Rx lists (D3, D4, D5, D7, D8) unless the NDC for the product is on the CMS Drug and Therapeutic Class Crosswalk. Section 8.3: Added Column E to D6 to collect the total number of member months covered during the reference year under the pharmacy benefit, including instructions on how to capture the data. Section 9.1: Clarified that when reporting information on retained rebates, if a PBM or other reporting entity is unable to obtain complete information regarding the rebates, fees and other remuneration received or retained by a plan, issuer or carrier, the reporting entity may report only the rebates, fees and other remuneration from any sources known to the reporting entity, and may assume that known amounts received by the plan, issuer or carrier were retained by the plan, issuer or carrier. To Read The Full Alert, Click Here

(By Julie Appleby) The system that is used to enroll people in federal Affordable Care Act insurance plans inadvertently allowed access by insurance brokers to consumers’ full Social Security numbers, information brokers don’t need. That raised concerns about the potential for misuse. The access to policyholders’ personal information was one of the problems cited in a KFF Health News article describing growing complaints about rogue agents enrolling people in ACA coverage, also known as Obamacare, or switching consumers’ plans without their permission in order to garner the commissions. The consumers are often unaware of the changes until they go to use their plan and find their doctors are not in the new plan’s network or their drugs are not covered. Agent Joshua Brooker told KFF Health News it was relatively easy for agents to access full Social Security numbers through the federal insurance marketplace’s enrollment platforms, warning that “bad eggs now have access to all this private information about an individual.” To Read More, Click Here