Archive for September 13th, 2010

Protected: Texas TPA Sues Seton Hospital – Cost Plus Reimbursement At Issue

Monday, September 13th, 2010

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Man Fined For Not Having Health Insurance

Monday, September 13th, 2010

“Navigator” – New Title For Soon To Be Extinct Health Insurance Agents

Monday, September 13th, 2010
“Considerable debate is occurring with regard to the role producers will play in the exchanges. The Patient Protection and Affordable Care Act creates a new entity called “navigators” that will assist consumers in the exchanges with public education, distribution of enrollment information and referrals. Beyond that, the law does not provide much detail on the role of navigators, so roles will need to be clarified further through the regulatory process. Producers are particularly concerned about how the navigator role is defined. To that end, at the National Association of Insurance Commissioners (NAIC) conference last month, the insurance commissioners approved a resolution that provides some insight on the role of producers and the role of navigators. The National Association of Health Underwriters (NAHU), which represents insurance producers, was pleased with the NAIC resolution.” 

HealthSmart – Baylor PPO Agreement

Monday, September 13th, 2010

HealthSmart Preferred Care II, LP (“HealthSmart”) has renegotiated its contract with Baylor Health System in North Texas , effective October 1, 2010.  As part of this new agreement, all HealthSmart Groups wishing to continue access to the Baylor Health System facilities and ancillary providers in the Dallas-Fort Worth area on or after October 1, 2010 must review and execute a Payor Acknowledgement form.  While each Payor must read the contract in its entirety to ensure a clear understanding of its obligations under the contract, Article II and Article IV are very important sections to review and understand.  For uninterrupted network access to services through Baylor, the Payor Acknowledgement form and accompanying documents must be signed no later than Friday, September 24th, 2010.

 Please understand that any client that chooses not to sign the attached Payor Acknowledgement form will not be granted in-network access or discounts for the Baylor Health System facilities or ancillary services after 10/1/2010.  For any Payor Acknowledgements received after September 24th, access may be granted, however, processing will require a minimum of 30 days for Baylor to activate such reinstatement.

Editor’s Note: For a complete copy of the HealthSmart/Baylor PPO Agreement, write