Announcements
JANUARY 9, 2023
NIVANO NEWSLETTER
Check out what Nivano Physicians is up to! Click below to read our monthly newsletter, Nivano News.
JANUARY 6, 2023
STATE OF EMERGENCY DUE TO WINTER STORMS
With the State of California entering a State of Emergency for severe winter storms, Nivano Physicians understands it may be hard for some of our members to get to appointments. We will be relaxing our authorization guidelines to help better service our members during these winter storms.
This includes reviewing and approving out of network provider authorizations/claims, medical equipment and supplies due to extreme weather. Nivano will also be relaxing the claims and authorization timeline requirements.
For any additional questions regarding authorizations, please reach out to your Patient Centered Care Consultant. If you are unsure of their contact information, you can email
PR@nivanophysicians.com or call us directly at 916.407.2000.
SEPTEMBER 2, 2022
HAPPY LABOR DAY
Nivano Physicians wishes all of you a Happy Labor Day and would like to celebrate the achievements of the American workforce! In celebration of Labor Day, Nivano Physicians will be closed Monday, September 5th, but will reopen Tuesday, September 6th at our normal operating hours.
DECEMBER 30, 2021
HAPPY NEW YEAR
May this upcoming year bring you continued happiness and peace! In celebration of New Years, Nivano Physicians will be closed on Saturday, January 1st and we will reopen on Tuesday, January 4th for our normal operating hours.
DECEMBER 24, 2021
HAPPY HOLIDAYS
We hope you have a wonderful holiday season spent with loved ones and filled with joy! In celebration of Christmas, Nivano Physicians will be closed on Saturday, December 25th and we will reopen on Tuesday, December 28th for our normal operating hours.
NOVEMBER 25, 2021
HAPPY THANKSGIVING
We hope you have an amazing Thanksgiving filled with loved ones and food! In celebration of Thanksgiving, Nivano Physicians will be closed on Thursday, November 25th and we will reopen on Monday, November 29th for our normal operating hours.
NOVEMBER 11, 2021
HAPPY VETERANS DAY
Nivano Physicians wishes all of you a Happy Veteran's Day and would like to commemorate the sacrifices of our veterans! In celebration of Veteran's Day, Nivano Physicians will be closed Thursday, November 11th, but will reopen Friday, November 12th at our normal operating hours.
SEPTEMBER 3, 2021
HAPPY LABOR DAY
Nivano Physicians wishes all of you a Happy Labor Day and would like to celebrate the achievements of the American workforce! In celebration of Labor Day, Nivano Physicians will be closed Monday, September 6th, but will reopen Tuesday, September 7th at our normal operating hours.
AUGUST 30, 2021
NIVANO'S NUTRITION PROGRAM
Our goal is to inform and empower our Medicare members to take ownership of their health. The Nivano Nutrition Program focuses on teaching patients on how to make sustainable lifestyle changes intended to positively impact their health. From reminding members about regular check ups and connecting them to resources within the community, to teaching them how to control their blood sugars and blood pressure, this program provides the tools necessary to make health a priority!
JULY 2, 2021
HAPPY 4TH OF JULY
Let us take the time to celebrate our freedom and our amazing country. Nivano Physicians will be closed Monday, July 5th in observation of the holiday, but will reopen Tuesday, July 6th for normal operating hours.
JUNE 22, 2021
ANNUAL WELLNESS VISIT TRAINING
WHEN: July 29th, 2021
TIME: 6pm-7pm
WHO: Presented by Alvin Sockolov, MD
We are inviting Nivano Providers to join our upcoming webinar to learn more about Annual Wellness Visits. In this webinar, Nivano will dive into the benefits of Annual Wellness Visits for all Medicare members.
We are offering $100 if you attend our AWV training. Dinner will be provided for attendees. Please let us know if you have any diet restrictions. If you are interested in participating in our training please email us at
PR@nivanophysicians.com.
MAY 31, 2021
HAPPY MEMORIAL DAY!
Let us honor those who fought for our freedom. In celebration of Memorial Day, Nivano Physicians will be closed Monday, May 31st, but will reopen Tuesday, June 1st for normal operating hours.
MARCH 8, 2021
INTERNATIONAL WOMENS DAY
Nivano Physicians would like to thank our women leadership team for everything that they do for #internationalwomensday !
Kimberly Bolton, Manager of Customer Service
Seema Chohan, RN, Director of Clinical Services
Dena Taylor, Director of Claims
Beanne Blando, Manager of Utilization Management
Veronica Van Orman, Director of Medicare Division and Network Development
Linette Roe, Chief Compliance Officer
Jessica Schafer, Manager of Marketing and Network Development
Katie Lazarus, Quality Management Supervisor
Olivia Martinez, Provider Relations Supervisor
Nicholette DiNardo, CRC, Director of Provider Relations and Quality Improvement
FEBRUARY 24, 2021
MOBILE MAMMOGRAMS
Nivano Physicians has collaborated with Alinea Mobile Imagining and is partnering with primary care providers and clinics in your area. Starting this Saturday February 26th, the mobile mammogram equipment will be in a local area for your convenience! We have dates available on Fridays and Saturdays throughout the greater Sacramento area. If you are due for a mammogram and would like to see when the unit will be in your area please call 916.407.2000.
FEBRUARY 15, 2021
HAPPY PRESIDENTS DAY
Happy Presidents Day to all of our leaders from Nivano Physicians! Our office will remain open today for normal business hours.
FEBRUARY 3, 2021
65 AND OLDER COVID-19 VACCINES
In order to register for the vaccine, you must be 65 years or older and living in Sacramento County. Valid photo ID must be brought to your appointment.
Vaccine Availability
There are roughly 200,000 people over the age of 65 in Sacramento County, and the vaccine supply is still extremely limited. At this time our appointment availability may be low and it may take a while for you to get into an open appointment slot. Sacramento County Public Health continues to urge patience as we work with our federal and state partners to expand capacity and supply in the weeks ahead.
Appointment Process
You must register online for an appointment. If you have difficulty making an appointment please reach out to us at 916.407.2000. Appointments are first come first served.
In Sacramento County, the following providers are currently offering vaccinations to their patients:
Dignity Health/Mercy Medical Group- Mercy patients aged 65 and older
Kaiser Permanente- Kaiser patients aged 75 and older
Sutter Health- Sutter patients aged 75 and older
UC Davis Medical Center- UCDMC patients aged 65 and older
California Northstate University- all members aged 65 and older
Sacramento State University- all members aged 65 and older
JANUARY 16, 2021
HAPPY MARTIN LUTHER KING DAY
Let us honor a great leader who had a dream to use freedom and love to gain equality. In celebration of Martin Luther King Jr., Nivano Physicians will be closed Monday, January 18th, but will reopen Tuesday, January 19th for normal operating hours.
JANUARY 14, 2021
PASSING OF PETER LEE- A TRUE FRIEND
It is with great sadness that we announce the passing of our dear friend, Peter Lee this last December. Peter was one of Anthem’s top Medicare Sales Managers, and had worked closely to help grow both Anthem and Nivano in the Sacramento Market. Mr. Lee is survived by his wife, son and daughter. Peter was a loving father and husband who was very dedicated to helping the Medicare population. His passion at Anthem was to help Medicare recipients understand the complexities of the system and know how to understand their health plan.
Peter had a courageous laugh and a heart of gold. He was truly one of the most caring individuals Nivano has seen. He would assist Nivano Physicians with any task that was requested with bundles of enthusiasm. Nivano Physicians sends prayers to the Lee family and knows that he is smiling down on all of us wishing us well.
DECEMBER 28, 2020
NIVANO NEWSLETTER Q4 2020
Find out what Nivano Physicians is up to! Click below to check out our quarterly newsletter, Nivano News!
DECEMBER 24, 2020
HAPPY HOLIDAYS!
Nivano Physicians wishes you happiness, joy and peace during this holiday season! Nivano Physicians will be closed Friday, December 25th, but will reopen Monday, December 28th for our normal operating hours.
DECEMBER 22, 2020
COVID-19 VACCINE
Recently the COVID-19 Vaccine from Pfizer and Moderna has been approved by the FDA. Since this is the first stage of the vaccine, there is a limited supply of the vaccine. First doses of the vaccine are being distributed to priority groups such as healthcare personal and residents of long term care facilities such as nursing homes.
The California government will be the ones to handle the distribution of the COVID-19 Vaccine. Look for updates in the link below as more doses of the vaccine become available for additional priority groups. While you are waiting for a vaccine please remember to social distance, wash your hands and wear a mask.
Medicare covers the COVID-19 vaccine so there will be no cost to you when it becomes available.
To read more please go to the
CDC's website by clicking HERE.
NOVEMBER 26, 2020
HAPPY THANKSGIVING
We hope you have an amazing Thanksgiving filled with loved ones and food! In celebration of Thanksgiving, Nivano Physicians will be closed on Thursday, November 26th and we will reopen on Monday, November 30th for our normal operating hours.
NOVEMBER 12, 2020
NIVANO PHYSICIANS MAXIMIZES REVENUE AND ACHIEVES OPERATIONAL GOALS
Based in Sacramento, California, surrounding 11 county regions, Nivano Physicians, is the leading provider of coordinated managed care services for both Medi-Cal and Medicare patients. Today they serve more than 75,000 active members in those surrounding counties. As change in healthcare is always a constant, Nivano Physicians today announced it has partnered with nThrive and its software, Claimshop (Medicare Grouping & Pricing edits) to help the California-based independent physician association (IPA) enhance their current administration platform.
Claimshop seamlessly integrates with QuickCAP™ 7.0, Nivano’s existing health benefits management solution created by software developer MedVision. Nivano wanted to ensure their positioning strategy was on track while entering into global risk agreements and CMS’s newest DCE models and to meet varied pricing methodologies around complex DRG / APG requirements.
The vision of Sarath Artham, CEO of Nivano Physicians, was to augment their already advanced use of technology of MedVision’s care coordination, eligibility & population health management, utilization review, claim adjudication, customer service, and various financial and analytical aspects in the healthcare payer markets. This is what led Mr. Artham to a partnership with nThrive for Claimshop.
The unified automation approach of Claimshop and QuickCap helps payors achieve measurable savings associated with repricing and claims flow automation, HIPAA-compliant electronic data interchange (EDI) programs, and contract management and modeling. Claimshop also allows payors to manage and track claim communication with their providers and other trading partners efficiently and securely.
Some other benefits experienced by Nivano Physicians’ combined strategy include:
- Reduce or eliminate initial startup costs
- Increase savings through reduced repricing costs
- Identify improper or inaccurate claim coding
- Improve reinsurance recoveries
- Improve contract management efficiency
- Automate repricing of the most difficult hospital and ancillary claims
- Increase repricing accuracy dramatically
- View pricing and track routing through the entire claims flow process
“Our seamless integration of QuickCap with nThrive’s Claimshop provide all Medicare proofing and pricing methodologies, and edits for our technical component agreement segments all in one service,” says Artham. “Other vendors charge differently per methodology, provide separate invoices for each, and require individual integrations. Now, with one integration point and one comprehensive invoice, we can improve efficiency and manage revenue through accurate and compliant pricing.”
About Nivano Physicians
Nivano Physicians is an Independent Physician Association (IPA) operating within Sacramento and surrounding counties. Nivano Physicians is a strong and committed advocate for the Medicare and Medi-Cal community--ensuring that managed health care is actually 'manageable.' The IPA educates and advises clients and physician participants and oversees their members’ managed health care needs. www.nivanophysicians.com.
About nThrive
nThrive's partner solutions help payor and provider technology vendors, healthcare services companies, medical billing companies and consultants create a strategic advantage by enhancing their technology and services without large investments in development and ongoing management.
Visit nthrive.com/partners to learn how nThrive’s partner solutions can enhance your healthcare technology applications and services.
About MedVision
MedVision, Inc. is an innovative software solutions provider to the healthcare industry of intuitive and integrated products to help organizations operate efficiently and provide them with a competitive advantage. MedVision’s flagship product, QuickCAP v7.0, is a complete health benefits software solution that leverages advanced technology to automate workflow, enable superior analytics, integrate business processes and improve patient outcomes, while reducing operating costs.
NOVEMBER 9, 2020
COVID-19 VACCINE
We have received some news from the Center for Medicare and Medicaid Services regarding administering the COVID-19 vaccine. Based on current information and projections, CMS has decided to add Part B coverage of a COVID-19 vaccine and its administration meets the significant cost threshold.
Medicare payment for COVID vaccinations administered during calendar years 2020 and 2021 to Medicare members will be made through the Medicare FFS program. Regarding payment for the administration of the COVID-19 vaccine, please submit all claims to the CMS Medicare Administrative Contractor (MAC) for payment.
NOVEMBER 6, 2020
HAPPY VETERANS DAY!
To all the brave soldiers who stood strong, to all who sacrificed greatly for our freedom, we thank you for your service. Nivano Physicians wishes all of you a Happy Veterans Day and honors all those who fought for our freedom. In celebration of Veterans Day, Nivano Physicians will be closed on Wednesday, November 11th and we will reopen on Thursday, November 12th for our normal operating hours.
OCTOBER 21, 2020
MEDICARE ENROLLMENT
Do you have questions about your Medicare plan? This Fall Nivano Physicians is hosting 27 meetings to help you enroll in Medicare. Call our Medicare Hotline at 844.402.3689 to reserve your spot or to get all your Medicare questions answered.
OCTOBER 14, 2020
NIVANO NEWSLETTER QUARTER 3
Find out what Nivano Physicians is up to! Click below to check out our quarterly newsletter, Nivano News.
SEPTEMBER 3, 2020
HAPPY LABOR DAY!
Nivano Physicians wishes all of you a Happy Labor Day and would like to celebrate the achievements of the American workforce! In celebration of Labor Day, Nivano Physicians will be closed Monday, September 7th, but will reopen Tuesday, September 8th at our normal operating hours.
JULY 23, 2020
NEW PO BOX
We recently have changed our PO Box. Please send all mail to our new PO Box address listed below.
Nivano Physicians IPA
PO Box 869140
Plano, TX 75086
As a reminder, claims can also be submitted electronically with our Payer ID:
MBA01.
For any additional questions regarding Nivano Physicians or our electronic funds transfer program, please reach out to your Provider Relations Representative. If you are unsure of their contact information, you can email PR@nivanophysicians.com or call us at 916.407.2000.
AUGUST 3, 2020
APOLLO MANAGED CARE GUIDELINES ADDED TO THE NIVANO PORTAL
As a valued partner of Nivano Physicians you have access to free guidelines though our provider portal. Through Apollo Managed Care guidelines, providers can get more immediate access to the identical guideline criteria that health plans and IPAs use in their care coordination efforts and referral authorization processes. Quicker access to the criteria means more efficient approvals, which further enhances turn-around times and improves overall satisfaction for both patients and providers.
This is an example of our seamless approach to improve your business workflow in the healthcare system. Physicians will now be able to use these guidelines that provide essential information to assist in medically-necessary benefit determinations, streamline the authorization process, and improve management of healthcare.
To view the Apollo guidelines within the Nivano Portal, follow the directions below:
Information Drop Down > Click Apollo Guidelines
Once there, you can search for any Apollo guideline.
JULY 21, 2020
NIVANO PHYSICIANS SELECTED BY THE HEALTHY PARTNERS PROGRAM TO COORDINATE SPECIALTY CARE ACROSS SACRAMENTO COUNTY
Nivano Physicians is proud to announce its selection by the Healthy Partners Program to Coordinate specialty care across Sacramento County, California.
“At Nivano Physicians, we strive to facilitate quality care for our members and be a strong resource to our physician network,” said Nivano Physicians' CEO, Sarath Artham. "I am looking forward to working with Sacramento County through this amazing program, and they entire staff is excited to help deliver specialty care to this underserved population."
Since 2016, the Healthy Partners Program has provided services to low-income, undocumented adults residing in Sacramento County who meet eligibility criteria. Services include primary care behavioral health, obstetrics and preventative care services, including immunizations, labs, radiology and access to some medical subspecialties. For more information, visit the Healthy Partners site.
Nivano Physicians and the Sacramento County Health Center are actively recruiting for more specialists to help expand services to this population. If you are interested in partnering with us to participate in the Healthy Partners Program, please reach out to us at 916.407.2000 ex. 2552.
JULY 14, 2020
EFT ACCESS
Nivano Physicians wants to ensure that all of our contracted providers are successful and that they receive their payments in a timely manner. As such, we would like to ask that all of our partners enroll in our Electronic Funds Transfer program. This ensures that there is no delay or issues in payments due to current circumstances as part of COVID-19. Specifically this will help expedite your claims and/or capitation payments while minimizing physical touching and participating in social distancing. If you have already enrolled in our Electronic Funds Transfer Program, please disregard this message and we thank you for enrolling.
We encourage you to use as many of our electronic offerings as possible during this time. Using these capabilities is simple and free, the following options are available:
- Deposit cap payments and claims directly into your checking account by enrolling in EFT (electronic funds transfer).
- Quickly request, receive, and view Authorizations via the Nivano portal.
- Send your claims electronically through your clearinghouse instead of mailing. Note, for most clearinghouses our payer ID is MBA01.
For any additional questions regarding electronic funds enrollment, or for questions about using any of these services, please reach out to your Provider Relations Representative. If you are unsure of their contact information, please email PR@nivanophysicians.com or call 916.407.2000.
JUNE 29, 2020
HAPPY INDEPENDENCE DAY
Nivano Physicians wishes all of you a Happy Independence Day and honors all those who fought for our freedom. In celebration of Independence Day, Nivano Physicians will be closed Friday, July 3rd, but will reopen Monday, July 6th at our normal operating hours.
MAY 20, 2020
HAPPY MEMORIAL DAY!
Nivano Physicians honors all of the fallen heroes and thanks them for the sacrifices they have made for our county. In celebration of Memorial Day, Nivano Physicians will be closed Monday, May 25th, but will reopen Tuesday, May 26th at our normal operating hours.
MAY 18, 2020
MEDICARE WEBINAR
Do you have questions about Medicare? From the comfort of your home, join our California licensed agents on your computer, tablet or smartphone to learn about Medicare. This interactive event covers the basics of Medicare. You have questions, we have answers.
You’ll learn:
• What Medicare covers
• How and when to enroll
• How much Medicare costs
• What Medicare plans are available to you
• What to do if you plan to keep working
• And much, much more…
Sign Up - anthemmed101.com/ca5
MAY 8, 2020
QUEST TEST KITS FOR MEDICARE MEMBERS
Nivano Physicians is offering Medicare members an easy way to complete preventative care measures from their home. Quest Diagnostics is providing at home kits to measure A1C, MicroAlbumin and Colorectal results. These tests are noninvasive and easy for members to conduct.
We are outreaching to Medicare members to verify each member's address. Once verified, members will be sent the necessary screening kits with a return kit and prepaid label for completed screenings. These tests are free for all Nivano Medicare members. The at home tests create a safe environment for members during the COVID-19 pandemic and provide access to preventative care without having to go see a physician. There is no action needed by physicians for members to receive the tests. Nivano Physicians and Quest will handle the outreach and delivery of the screening tests.
For any additional questions regarding the Quest Health Connect Program, please reach out to your Provider Relations Representative. If you are unsure of their contact information, you can email PR@nivanophysicians.com or call 916.407.2000.
MAY 8, 2020
REMOTE BLOOD PRESSURE MONITORING PROGRAM
Nivano Physicians is working hand in hand with our healthcare partner Optima Health to provide a safe way to measure blood pressure readings on hypertensive members. We are working to deliver blood pressure cuffs to Medi-Cal members who are at risk or who have high blood pressure. The blood pressure cuffs provide members with a dedicated health resource that is readily available and will help them reach a healthy blood pressure range. This program focuses on Medi-Cal members that have had high blood pressure results in 2019 and 2020.
This program will be administered remotely by our partner, Optima Health:
- Optima will be monitoring each member’s blood pressure by providing a free blood pressure cuff.
- The blood pressure cuff sends the results directly to the members primary care physician and Nivano Physicians.
- Participating providers must give Optima access to their EMR. Optima will send monthly reports back to participating providers with all care notes and will also chart them in the EMR.
- Each provider must bill the procedure codes provided in order for Quality measures to be met using encounter data.
For any additional questions regarding the Remote Blood Pressure Monitoring Program, please reach out to your Provider Relations Representative. If you are unsure of their contact information, you can email PR@nivanophysicians.com or call 916.407.2000.
APRIL 20, 2020
COVID-19 AND MEDICARE ENROLLMENT
Please remember to stay healthy and safe during this time. Join Nivano's Medicare plan today. Call 916.516.2101 or visit nivanophysicians.com/medicare for more information.
APRIL 16, 2020
COVID-19 HEDIS AND QUALITY STRATEGIES
Due to the recent outbreak of COVID-19, we all have made significant changes in how we live and work. A big area of focus every year for those working within the managed care module is HEDIS and Quality. With the many changes still happening, we found the need to adapt and devise a COVID-19 Quality Strategy and Post COVID-19 Quality Strategy.
COVID-19 Quality Strategies
Medication Adherence & Mail Order Pharmacies
1/3 of our quality measures are for medication adherence. During this time, the state has allowed for up to 100 days supply. Providers can use telehealth services to help members transition to receiving medications through the mail. Mail Order Pharmacies
Mail Order Pharmacies
Aetna: 877.238.6211 or submitted online via Availity or faxed to 877.270.3317
Anthem: 833.203.1738 or www.ingenio-rx.com/physicians/
Molina: 888.665.4621 or can be e-prescribed
Keep this in mind for the below Measures:
- AMR – Asthma Medication Ratio: 50% or More prescribed controlled medications.
- ART - Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis: at least DMARC 1 Rx in MY 2020.
- OMW - Osteoporosis Management in Women Who Had a Fracture: 1 Osteoporosis Rx in MY 2020 within 6 Months of fracture.
- Medication Adherence Measures: Statin Therapy for Patients with Cardiovascular Disease (SPC)- Received Statin Therapy, Statin Compliance: Cholesterol Medications, ACEARB Compliance: Blood Pressure Medications, DIA Compliance: Diabetes Medications, Statin Use in Persons with Diabetes
Medicare Annual Well Visits and Care for Older Adults (COA)
The visits G0438 and G0439 can be done via telehealth. Care for older adults can be done over the phone by Medical assistants. Only Medication Review requires PCP or Pharmacist.
Advanced Care Planning
- CPT Code 1123F: ACP discussed
- CPT Code 1124F: ACP discussed, patient unable to name or provide care plan
- CPT Code 1157F,1158F: ACP present in medical record
- CPT Code S0257: Discussion regarding ACP or end of life discussed with patient or surrogate
- 99497: ACP explanation and standard forms completed by physician\
Functional Status
- CPT Code 1170F: Functional Status Assessed
Pain Screening
- CPT Code1125F: Pain Severity Quantified; pain present
- CPT Code 1125F: Pain Severity Quantified; no pain present
Medication Review (Practitioner Only)
- CPT Codes 1159F AND 1160F: Medication list documented and reviewed by practitioner
CMS has stated that Medicare Advantage (MA) organizations and other organizations that submit diagnoses for risk adjusted payments are able to also submit these diagnoses for telehealth visits if the visit includes an audio and video component.
For any additional questions regarding HEDIS and quality measures during this time, please reach out to your Provider Relations Representative. If you are unsure of their contact information, you can email PR@nivanophysicians.com or call us at 916.407.2000.
MARCH 18, 2020
REIMBURSEMENTS FOR TELEMEDICINE VISITS
In an effort to ensure our providers can continue giving care during these hectic times, Nivano Physicians will be reimbursing all contracted providers who are seeing patients through telemedicine visits. Reimbursement rates will be based on your current contracted rates.
Telemedicine visits are defined by HR6074 Section 102 as having audio and video. For Medi-cal patients, you can bill an evaluation and/or management (E/M) codes (for example, 99213, 99214) along with a telehealth Place of Service (POS) code 2 and potentially a modifier such as code “95”. These can be billed and submitted directly to Nivano. The referral process will work the same, and most specialty visits will still require initial authorization.
For Medicare members, please submit telemedicine visits directly to Anthem Blue Cross.
You can use the following codes:
99441-99443-Physician via telephone.
98966-98968-Non-Physician via telephone.
*Add Modifier -GT to the appropriate E&M outpatient visit if via real-time Audiovisual telecommunication.
POS = Office (or facility where provider is present)
For additional information please visit:
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://www.dhcs.ca.gov/provgovpart/Pages/TelehealthFAQ.aspx
https://www.medicaid.gov/medicaid/benefits/telemedicine/index.html
MARCH 9, 2020
COVID-19
As the State of California responds to COVID-19, Nivano Physicians and the Department of Managed Health Care are taking action to ensure that cost does not affect members' access to medically necessary screening and testing for COVID-19.
Gavin Newsom, Governor State of California
Health and Human Services Agency
DEPARTMENT OF MANAGED HEALTH CARE
980 9th Street, Suite 500 Sacramento, CA 95814
Phone: 916-324-8176 | Fax: 916-255-5241
www.HealthHelp.ca.gov
ALL PLAN LETTER
DATE: March 5, 2020
TO: All Full-Service Commercial and Medi-Cal Health Care Service Plans
FROM: Sarah Ream Acting General Counsel
SUBJECT: APL-20-006 COVID-19 Screening and Testing
As the State of California responds to COVID-19, the Department of Managed Health Care (DMHC) is taking action to ensure that cost does not inhibit enrollees’ access to medically necessary screening and testing for COVID-19.
Waiver of Cost-Sharing Amounts
The DMHC directs all full-service commercial plans and full-service Medi-Cal plans to do the following:
1. Immediately reduce cost-sharing (including, but not limited to, co-pays, deductibles, or coinsurance) to zero for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits, and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.
2. Notify, as expeditiously as possible, the plan’s contracted providers that the plan is waiving cost-sharing as described above.
3. Ensure the plan’s advice line/customer service representatives are adequately informed that the plan is waiving cost-sharing as described above and clearly communicate this to enrollees who contact the plan seeking medically necessary screening and testing for COVID-19.
4. Prominently display on the plan’s public website a statement that the plan is waiving cost-sharing for medically necessary screening and testing for COVID19.
Ensuring Enrollees Have Timely Access to Care
The DMHC reminds plans of existing California laws that require plans to ensure their enrollees are able to access medically necessary care in a timely fashion. These laws include:
• Covering all medically necessary emergency care without prior authorization, whether that care is provided by an in-network or out-of-network provider. (Health and Safety Code section 1371.4.)
• Complying with the utilization review timeframes for approving requests for urgent and non-urgent services, as required by Health and Safety Code section 1367.01. The DMHC strongly encourages plans to waive prior authorization requests for services related to COVID-19; at a minimum, plans are encouraged to respond to such requests more quickly than the timeframes required by law.
• Ensuring the plan’s provider networks are adequate to handle an increase in the need for health care services, including offering access to out-of-network services where appropriate and required, as more COVID-19 cases emerge in California.
• Ensuring enrollees are not liable for unlawful balance bills from providers, including balance bills related to testing for COVID-19.
• Ensuring plans have 24-hour access to a person with the authority to authorize services and ensuring the DMHC has contact information for that person, as required by Health and Safety Code section 1371.4 and California Code of Regulations, sections 1300.67.2.2 and 1300.68.01.
Proactive Steps
Finally, the DMHC encourages plans to act proactively to ensure enrollees can access all medically necessary screening and testing for COVID-19. To this end:
• Plans should work with their contracted providers to use telehealth services to deliver care when medically appropriate, as a means to limit enrollees’ exposure to others who may be infected with COVID-19, and to increase the capacity of the plans’ contracted providers.
• In the event of a shortage of any particular prescription drug, plans should waive prior authorization and/or step therapy requirements if the enrollee’s prescribing provider recommends the enrollee take a different drug to treat the enrollee’s condition.
The DMHC continues to closely monitor this situation and will issue further guidance as appropriate. In the meantime, if you have questions or concerns, contact your plan’s assigned licensing counsel.
JANUARY 13, 2020
PRESENTING NIVANO 24/7 MESSAGING!
Nivano Physicians would like to introduce our Nivano 24/7 messaging service! Accompening our Nivano 24/7 phone service, the messaging service will also be able to answer your claims, authorization and eligibility questions at the touch of your fingertips. In order to initiate a conversation with Nivano 24/7, please text hi, hello, Nivano or any word to 916.318.3168 at any time.
To review a Claim, eligibility or authorization status reply in the formats listed below:
CLM [DateOfService]
AUTH [RequestDate]
ELG [DateOfService]
Example: CLM 12345678 07/05/1990 10/20/2019
Please do not type the pointed or square brackets. There should be a single space between each word in the syntax. Please use MM/DD/YYYY format for date. Details within pointer brackets < > are mandatory. Details enclosed in square brackets [ ] are optional. The latest five records will be shown in case of multiple entries.
If you have any questions, please call us toll free at 844.889.2273.
JANUARY 1, 2020
NOW OPEN SATURDAYS
Starting January 2020, we are open on Saturdays from 9 am to 4 pm. We hope to assist our members and contracted providers better with these extended hours!
Reach us toll free at 844.889.2273 for any assistance.
DECEMBER 10, 2019
FOOD DRIVE
Nivano Gives Back!
This year, Nivano's holiday gift is partnering with Francis House Center to hold a food drive for those in need. The food drive will be on Monday, December 16, 2019 from 9:00 AM to 11:00 AM, located at 1422 C Street, Sacramento, CA 95814. We thank all of our valued providers as they have allowed for this wonderful opportunity to happen.
AUGUST 21, 2019
INTRODUCING NIVANO 24/7!
We are happy to announce the launch of the Nivano 24/7 automated phone system! At Nivano, we are constantly searching for the best technology solutions to help further streamline our business processes. By automating the most common and time-consuming calls such as checking claim and authorization status or verifying eligibility, we are allowing more time for our customer service team to assist callers with important care coordination needs. Nivano 24/7 is helping to improve our member care 24 hours a day!
JUNE 27, 2019
NIVANO PHYSICIANS GAINS ANTHEM MEDICARE CONTRACT
Leading Independent Provider Association Nivano Physicians, Inc. Announces Medicare Contract with Anthem BlueCross
SACRAMENTO, Calif., June 27, 2019 (GLOBE NEWSWIRE) -- One of Northern California’s leading Independent Physician Associations (IPA), Nivano Physicians, Inc., today announced the signing of a Medicare contract with Anthem BlueCross. Effective July 1, 2019, Sacramento County Medicare enrollees under the Anthem BlueCross managed care plan will have the option of selecting Nivano Physicians as their IPA with a coverage effective date of August 1, 2019.
Nivano Physicians boasts an expansive and diverse network of more than 900 primary care providers, specialists, hospitalists, and ancillary providers – experiencing a 30 percent growth from this time last year. “Our goal is to ensure that all of our new Medicare enrollees receive high-quality care through our network of providers anywhere in the county,” states Paul Dobrovolsky, Director of Network Operations for Nivano Physicians.
“We see this new endeavor as a great step for our company. Anthem BlueCross is one of our closest partners and we feel fortunate to have the opportunity to expand our relationship with them. Our agreement is truly a testament to how far we have come in the last 14 months as an organization,” says Sarath Artham, CEO for Nivano Physicians.
Mr. Artham goes on to state, “A primary reason Nivano Physicians has been successful in adding managed Medicare back into our business model is due to our comprehensive operations and technology infrastructure operated through MedVision’s QuickCap (QC7) platform and other inter-related technologies. Our ability as an IPA to manage STAR ratings, HEDIS scores and other such metrics gives our health plan partners peace of mind knowing that Nivano Physicians understands and has what it takes to succeed as a risk-based organization.”
About Nivano Physicians
Nivano Physicians is an Independent Physician Association (IPA) operating within Sacramento and surrounding counties. Nivano Physicians is a strong and committed advocate for the members within our community – ensuring that managed health care is actually “manageable.” The IPA educates and advises clients and physician participants and oversees their members’ managed health care needs. Learn more at www.nivanophysicians.com.
About Anthem, Inc.
Anthem is a leading health benefits company dedicated to improving lives and communities and making healthcare simpler. Through its affiliated companies, Anthem serves more than 78 million people, including over 40 million within its family of health plans. Anthem aims to be the most innovative, valuable and inclusive partner. For more information, please visit www.antheminc.com. In California, Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.
Contact:
Deanna McQuillan, Director of Operations
deannam@nivanophysicians.com
www.nivanophysicians.com
JUNE 3, 2019
YUBA COMMUNITY RESOURCE FAIR *RESCHEDULE*
The Yuba-Sutter- Colusa United Way Community Resource Fair has been rescheduled! We hope to see all of you there.
Yuba-Sutter-Colusa United Way
Community Resource Fair
“Assisting Those In Need”
Saturday, August 17, 2019
10:00 am - 1:00 pm
Location: Gauche Park (Wilbur Ave. and C St., Yuba City)
APRIL 4, 2019
CHECK OUT OUR NEW PROVIDER APP
The Nivano Physicians mobile application was made to allow practice management and key decision makers within their organizations to make informative business decisions regarding their membership with Nivano. The mobile application features include claim aging summaries, membership totals by health plan, address lists, referral trends and our real-time HEDIS Report Card. By implementing this tool, providers are able to focus on patient care while successfully monitoring their bottom line.
MARCH 29, 2019
KIDS DAY IN THE PARK
Come join Nivano Physicians while we support the Kids Day in the Park in Rancho Cordova! The event features free family fun including rides, crafts, games, and more.
Saturday, April 27th from 11 am - 3 pm at Hagan Park
2197 Chase Drive, Rancho Cordova
FEBRUARY 18, 2019
NEW MOLINA HEALTHCARE MEDI-CAL CONTRACT
Nivano Physicians, Inc. and Molina Healthcare Sign Medi-Cal Agreement
SACRAMENTO, Calif., Feb 18, 2019 (GLOBE NEWSWIRE via COMTEX) -- SACRAMENTO, Calif., Feb. 18, 2019 (GLOBE NEWSWIRE) -- Nivano Physicians, Inc., a California-based Independent Physician Association (IPA), today announced the signing of a Medi-Cal contract with Molina Healthcare effective February 1, 2019. Sacramento county managed care Medi-Cal enrollees under Molina Healthcare will now have the option of receiving their primary care and specialty care services through Nivano Physicians thanks to the newly-signed agreement. Nivano Physician boasts an expansive and diverse network of over 700 primary care providers, specialists, hospitalists and ancillary providers.
"Our team has been working around the clock with Molina to reach this agreement. We are thrilled for the opportunity to work with a progressive health plan like Molina, and we look forward to offering comprehensive coverage for Medi-Cal recipients in Sacramento county. The new Nivano - Molina contract is expected to benefit many thousands of Medi-Cal managed care enrollees in Sacramento County. We feel this will be welcomed news to the Sacramento community, as Nivano Physicians continues in its mission and vision to serve those in need with the best possible network of physicians," said Sarath Artham, CEO of Nivano Physicians.
About Nivano PhysiciansNivano Physicians is an Independent Physician Association (IPA) operating within Sacramento and surrounding counties. Nivano Physicians is a strong and committed advocate for the Medi-Cal community--ensuring that managed health care is actually 'manageable.' The association educates and advises clients and physician participants and oversees their managed health care needs. www.nivanophysicians.com
About Molina Healthcare
Molina Healthcare, a FORTUNE 500, multi-state health care organization, arranges for the delivery of health care services and offers health information management solutions to nearly five million individuals and families who receive their care through Medicaid, Medicare and other government-funded programs in fifteen states. www.molinahealthcare.com
For more information contact:
Deanna McQuillan
Operations & HR Manager | Nivano Physicians
916-407-2000 | deannam@nivanophysicians.com
FEBRUARY 4, 2019
APOLLO MEDICAL CRITERIA IMPROVING NIVANO'S WORKFLOW
Integration of Apollo Managed Care Guidelines into Nivano Physicians’ workflow will place the required criteria for managing care at providers’ fingertips within its network – improving care coordination
SACRAMENTO, Calif., Feb. 04, 2019 (GLOBE NEWSWIRE) -- Nivano Physicians, Inc., a California-based Independent Physician Association (IPA), today announced the expansion of its Apollo Managed Care guidelines, allowing their 700+ Primary Care and Specialist Physicians to directly access the guidelines through its integrated QuickCap administration platform provided by MedVision, Inc. Providers can get more immediate access to the identical guideline criteria that health plans and IPAs use in care coordination and referral authorization processes at the point of making any referral request. Quicker access to the criteria means more efficient approvals, which further enhances turn-around times and improves overall satisfaction for both patients and providers.
“Provider offices that were surveyed following the rollout of this important access ability have given us the positive feedback and acceptance we had hoped for from our network providers. Physicians and their staff feel that understanding in advance the various elements that make up the criteria for managing care and in how health plans and IPAs evaluate and approve referral requests is a timesaver, ultimately benefiting health plan members,” said Sarath Artham, CEO and Chief Technological Officer, Nivano Physicians. “The goal with our integrated technologies and single point of access is to mitigate or remove any potential roadblocks in service to our physicians and the populations we mutually serve each and every day.”
“This is yet another example of an improved, seamless approach of business workflow in healthcare. Applying proven administration components of QuickCap coupled with guidelines from Apollo Managed Care and implementing them with virtually immediate access for providers, Nivano Physicians sets itself apart as a very progressive managed care organization,” said Albert Sosa, CEO, MedVision, Inc.
“Physicians will be able to use these guidelines that provide essential information to assist in medically-necessary benefit determinations, streamline the authorization process, and improve management of medical and behavioral health care,” said Margaret Bischel, MD, CMO, Apollo Managed Care.
About Nivano Physicians
Nivano Physicians is an Independent Physician Association (IPA) operating within Sacramento and surrounding counties. Nivano Physicians is a strong and committed advocate for the Medi-Cal community—ensuring that managed health care is actually ‘manageable.’ The association educates and advises clients and physician participants and oversees their managed health care needs. www.nivanophysicians.com
About Apollo Managed Care
Apollo Managed Care has been providing the medical community with affordable review criteria and clinical guidelines since 1997. The comprehensive solution offers online access to more than 2,800 detailed clinical review criteria guidelines and evidence-based benefit interpretations that include benchmarks for commercial, Medicare and Medicaid populations. Apollo continues to be one of the industry’s most widely-trusted resources supporting medically necessary and evidence-based healthcare.
http://apollomanagedcare.com/
About MedVision, Inc.
MedVision, Inc. is an innovative software solutions provider to the healthcare industry of intuitive and integrated products to help organizations operate efficiently and provide them with a competitive advantage. MedVision’s flagship product, QuickCap v7.0, is a complete health benefits software solution that leverages advanced technology to automate workflow, enable superior analytics, integrate business processes and improve patient outcomes while reducing operating costs. https://www.medvision-solutions.com/
For more information contact:
Deanna McQuillan
916-407-2000
Marketing@nivanophysicians.com
http://www.globenewswire.com/news-release/2019/02/04/1709945/0/en/Nivano-Physicians-Inc-and-Apollo-Managed-Care-Together-Supporting-Provider-Networks.html
DECEMBER 3, 2018
NIVANO PHYSICIANS COLLABORATION WITH QUALMETRIX
Nivano Physicians Selects Qualmetrix for Advance Analytics and Population Health Management
Provider Organizations Require an Analytic Platform to Promote Physician Engagement Which Will Help Drive Quality Improvement and Cost Effectiveness
MIRAMAR, FLORIDA, USA, December 3, 2018 /EINPresswire.com/ -- MIAMI December 3, 2018 Qualmetrix, a leader in Advanced Analytics and Population Health, announced today that Nivano Physicians has selected its platform to help the California-based independent physician association (IPA) enhance the quality of care it delivers to its patient population. Qualmetrix quickly integrated the data provided by Nivano Physicians so that they were operational within 30-days following receipt of data.
The integration of the Qualmetrix Analytic Platform into the workflow of Nivano Physicians will allow enhanced population health management, drive physician performance, and improve control of cost and utilization within their organization
“Our team at Nivano Physicians has wholeheartedly embraced the Qualmetrix platform. We are finding that Qualmetrix’s ease of use provides a significant enhancement to our core platform and allows us to improve the quality of care we give to our patients. The ability to swiftly identify opportunities to improve the care of our patients in a cost-effective fashion is of paramount importance to us and the Qualmetrix platform allows that to happen,” said Sarath Artham, CEO and Chief Technological Officer, Nivano Physicians.
“The healthcare industry continues to experience the loss of billions of premium dollars to overutilization and inappropriate use of services. The Qualmetrix platform helps healthcare organizations like Nivano enhance the care delivered to its patients by identifying opportunities to engage its physicians with data to drive continued quality improvement.” said Lawrence Schimmel, M.D., Chief Medical Officer of Qualmetrix.
About Qualmetrix
QualMetrix is an outcomes-driven analytics company, providing turnkey SaaS solutions that enable connected intelligence across the care continuum by transforming massive amounts of data into actionable insights. Our solution creates transparency enabling its clients to deliver impactful population health initiatives. Additionally, QualMetrix offers solutions that help you identify and limit overutilization, reduce unnecessary care and deviations from best practices to help control c.
NOVEMBER 6, 2018
NIVANO'S PARTNERSHIP WITH PCG SOFTWARE
Nivano Physicians Selects PCG’s Flagship Software to Monitor and Enhance the Internal Claims Process
Nivano Physicians has partnered with PCG Software to roll out their flagship software product, Virtual Examiner®. Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. “Our team at Nivano Physicians has wholeheartedly embraced the Virtual Examiner system. We are finding VE’s ease of integration to our core platform and ability to swiftly apply millions of edit rules in adjudication, identifying issues prior to check-runs truly has helped minimize and practically eliminate problems of overpayment today,” said Sarath Artham, CEO and Chief Technological Officer, Nivano Physicians.
To read the full article, click this link: http://pcgsoftware.com/news/nivano-physicians-selects-pcgs-flagship-software-to-monitor-and-enhance-the-internal-claims-process/.
JUNE 4, 2018
NEW PROVIDER PORTAL
We are now live with our new Provider Portal through QuickCap!
To request access to sign in and view claims, request authorizations, and more, please go to https://nivano.quickcap.net. You will be directed to the login page where you can click "First time users, Click Here" to request access. Please see the screenshot below for further reference. Training for the new online portal can be provided by your provider representative, Sable DeGuzman, either online through WebEx or in person.
