Managed Care
Managed Care Topics
Increasing practice costs, decreasing reimbursement rates, administrative hassles, and lack of transparency and consistency in insurers' claims-processing rules continue to plague New Jersey's physicians. Review the progress that MSNJ is making on these "bottom-line" issues by…
- SEEKING FAVORABLE LEGISLATION: MSNJ is actively pursuing legislation to force healthcare insurers to treat physicians fairly by requiring full disclosure, timeliness, and transparency in claims processing rules and policies. To learn about the issues we are pursuing, including heavy-handed recoupment practices, go to the Managed Care Resources index below.
- SUING MAJOR HEALTHCARE INSURERS: MSNJ is among the prominent medical societies that are taking major healthcare insurers to task by filing, settling, and litigating national class-action lawsuits. The suits allege that the insurers conspired to deny and delay payments. Now we are ensuring that the settling insurers (Aetna, CIGNA, and HealthNet) are living up to the terms of their agreements through the compliance process.
- HELPING MEMBERS WITH DENIED CLAIMS: MSNJ is helping members pursue claims that have been wrongfully denied through the Claims Assistance Program.
- HELPING PRACTICE MANAGERS: MSNJ is helping practice managers to handle the maze of managed care rules and regulations and to enforce the national class-action settlement agreements. MSNJ's Medical Practice Managers Section (MPMS) has recently begun a List-Serve which allows MPMS members to share information on managed care issues. Recent seminars include: how to enforce compliance with national class-action lawsuits (Aetna, CIGNA, and HealthNet) and evaluating managed care contracts.
COMMUNICATING ON MANAGED CARE: Managed care news is communicated through blast-faxes, MSNJ e-News and Physician Advocate articles. We also post information on MSNJ's new List Server for Medical Practice Managers.
Managed Care Resources
Payment Issues: