NJ DOBI Independent Health Care Appeals Program for Prior Authorization Denials
Blog: In the News ... | Posted By: Amanda Shiber | Released: April 26, 2018, 6:44 am
The NJ Department of Banking & Insurance administers an external review program for prior authorization denials for procedures and prescriptions. Since 2014, physicians are required to post notice regarding the Independent Health Care Appeals Program (IHCAP) in their office.
IHCAP is available to
UHC, Oxford, Americhoice Fined $2.5 Million for Regulatory Violations
Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: April 5, 2018, 11:26 am
The Department of Banking & Insurance (DOBI) fined UnitedHealthcare (UHC), Oxford and Americhoice $2.5 million for regulatory violations, some of which MSNJ brought to DOBI’s attention based on our members’ complaints. In particular, we asserted that UHC could not require physicians to provide patie
Blog: In the News ... | Posted By: Mishael Azam, Esq. | Released: March 1, 2018, 7:50 am
Continue to encourage your patients to get vaccinated! The flu vaccine is 36% effective this season and has been most effective for young children, according to interim estimates the Centers for Disease Control and Prevention (CDC) released [February 15th]. “These early VE (vaccine effectiveness) es
2017 MIPS Claims Data Performance Scores Now Available on QPP Website
Blog: In the News ... | Posted By: Amanda Shiber | Released: February 15, 2018, 9:41 am
If you submitted quality data via claims for the 2017 reporting year, you may now view your performance scores at: https://qpp.cms.gov/login by using the data submission feature.
Submitting Quality Performance Data via Claims
If you’ve already submitted quality data via claims, you don’t have to t
New United Opioid Coverage Policy
Blog: In the News ... | Posted By: Mishael Azam, Esq. | Released: February 8, 2018, 12:35 pm
New to Therapy Short-Acting Opioid Supply and Daily Dose Limits for UnitedHealthcare Community Plan and UnitedHealthcare Commercial Plans – Effective March 1, 2018.
Beginning March 1, 2018, UnitedHealthcare Community Plan in some states and UnitedHealthcare commercial plans will implement a short-
State Adopts Rules on Health Claims Processing & Payment Act
Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: February 8, 2018, 11:55 am
The Department of Banking & Insurance adopted regulations implementing the Health Claims Authorization Processing & Payment Act (HCAPPA) which was passed in 2006. MSNJ filed comments joined by the NJ Association of Osteopathic Physicians & Surgeons, NJ Society of Interventional Pain Physicians, New
DOJ Seeks More Information on Proposed CVS-Aetna Merger
Blog: In the News ... | Posted By: Melinda Martinson, Esq. | Released: February 8, 2018, 11:36 am
On February 1, the Department of Justice made a second request for information concerning CVS’s attempt to merge with Aetna to create an integrated health system. Those who attended MSNJ’s last Policy & Strategy Panel meeting heard potential anti-trust concerns from the AMA which is carefully analyz
Medicare Mammography Payment Issue
Blog: In the News ... | Posted By: Amanda Shiber | Released: February 1, 2018, 7:46 am
Practices that perform mammography are urged to review their Medicare claims dating back to October 1, 2017 to ensure proper payment. There was a system edit, causing the rejection of mammography claims using new, more specific ICD-10 codes. The edit has now been deactivated and these claims may be
Prior Authorization Progress
Blog: In the News ... | Posted By: Amanda Shiber | Released: January 26, 2018, 11:58 am
MSNJ supported the AMA in its Prior Authorization and Utilization Management Reform Principles in early 2017. As a result of publication of these principles, a workgroup comprised of the AMA, the American Hospital Association, America's Health Insurance Plans, American Pharmacists Associati
Tiered Network Surveys
Blog: In the News ... | Posted By: Melissa Zarzycki | Released: January 26, 2018, 11:48 am
In anticipation of a Senate hearing on OMNIA, MSNJ has published new Tier 1 and Tier 2 surveys to collect information from our members to help inform our testimony before the Legislature. Members are encouraged to complete the appropriate survey for their OMNIA tier designation.