San Francisco Marin Medical Society Blog

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CMS Approves Medicare/Medi-Cal Duals Project

The Department of Health Care Services (DHCS) announced that CMS has given approval to the project to require Medicare/Medi-Cal dual eligibles to enroll in a managed care plan. The project, which was previously known as the “Coordinated Care Initiative,” will now be called CalMediConnect.

Medicare Ordering/Referring Claims Denials to Take Effect May 1

Medicare will begin denying claims on May 1, 2013, if the ordering/referring provider listed on the claim is not in the Provider Enrollment, Chain and Ownership System (PECOS), the database Medicare uses to track physicians and other providers.

Blue Shield Requires Physicians to Notify Patients Before Referring Out-of-Network

On March 15, Blue Shield announced that it would soon begin requiring contracted physicians to notify patients in writing before making out-of-network referrals. Effective May 15, physicians will be required to notify patients in writing using a form provided by the payor when referring a patient to an out-of-network provider.