Effective July 1, 2017, California law (AB 72) requires fully insured commercial payors to make “interim payments” to non-contracted physicians for covered, non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges.

The California Medical Association (CMA) is monitoring implementation of this new law very closely. CMA is also working hard to ensure health plans and insurers do not game the system to pay artificially low reimbursement rates to physicians. As part of this effort, CMA recently hired a dedicated advocate focused on helping members navigate the new AB 72 billing restrictions for out-of-network services at in-network facilities. The new advocate in CMA’s Center for Economic Services, Juli Reavis, can be reached at (888) 401-5911 or jreavis@cmadocs.org.

If your practice experiences a change in payor behavior regarding contract negotiations, claims payment or network adequacy concerns, or is experiencing other challenges, do not hesitate to contact CMA. “If you’re concerned about whether or not you’re being paid correctly under AB 72, or you need help navigating the law and its restrictions, call me. I can help,” said Reavis.

To learn more about this law, find out if payors are reimbursing you correctly and learn how to dispute the interim rate, visit CMA’s AB 72 Resource Center.

Contact: Reimbursement Helpline, (888) 401-5911 or economicservices@cmadocs.org.