![]() ![]() If you or a member of your family enrolled in health insurance coverage for 2022 through a Marketplace, you should have received Form 1095-A, Health Insurance Marketplace Statement, from the Marketplace. This includes a qualified health plan purchased on or through a State Marketplace. ![]() As a result, you should complete Form 8962 only for health insurance coverage in a qualified health plan purchased through a Marketplace. You may take the PTC (and APTC may be paid) only for health insurance coverage in a qualified health plan (defined later) purchased through a Health Insurance Marketplace (Marketplace, also known as an Exchange). Use Form 8962 to figure the amount of your premium tax credit (PTC) and reconcile it with advance payment of the premium tax credit (APTC). 974, Premium Tax Credit for information on determining QSEHRA affordability and Notice 2017-67 for additional guidance on QSEHRA coordination with the PTC. Also see Qualified Small Employer Health Reimbursement Arrangement in Pub. ![]() For more information, see Column (e) under Line 11-Annual Totals or Lines 12 Through 23-Monthly Calculation, later. If the QSEHRA is unaffordable for a month, you must reduce the monthly PTC (but not below -0-) by the monthly permitted benefit amount and you must enter “QSEHRA” in the top margin on page 1 of Form 8962 to explain your entry and avoid delay in the processing of your return. If the QSEHRA is affordable for a month, no PTC is allowed for the month. If you were covered under a QSEHRA, your employer should have reported the annual permitted benefit in box 12 of your Form W-2 with code FF. Under a QSEHRA, an eligible employer can reimburse eligible employees for medical expenses, including premiums for Marketplace health insurance. Physicians with questions are encouraged to contact Anthem Network Relations at a summary of California's unfair payment practices law, see " Know Your Rights: Identify and Report Unfair Payment Practices" More information on timeframes for claim submission can be found in “ Know Your Rights: Timely Filing Limitations” or in CMA health law library document #7511, “ Payment Denials by Managed Care Plans and IPAs.” available free to members on CMA’s Reimbursement Assistance page.Qualified small employer health reimbursement arrangement (QSEHRA). As a reminder, California law states plans must allow a minimum of 180 days from the date of service for receipt of a claim for non-contracted providers. Remember, even if a physician fails to submit a claim on time, California law provides a “good cause” exception that requires payors to accept and adjudicate a claim if the physician demonstrates, upon appeal, “good cause” for the delay.Īnthem has clarified that the change does not affect non-contracting physicians. CMA is assessing the issue to determine potential next steps. While the change in Anthem’s claim submission timeframe meets the minimum timeframe allowed by law for contracting physicians, the California Medical Association (CMA) has received several calls from physicians concerned that the June 21 letter of the material contract change was not sufficient advance notice, given the policy change impacts claims with July dates of service.Īs a result of CMA sponsored unfair payment practices law and the resulting regulations, plans are required to provide a minimum of 45 days prior written notice before instituting any changes or amendments about claim submission requirements.ĬMA raised this concern with Anthem, but the payor believes it provided sufficient advance notice. However, as an example, the notice indicates that the change will impact claims with July dates of service if not submitted within 90 days. Under the new requirement, all claims submitted on or after October 1, 2019, will be subject to the new 90 day filing requirement. Anthem Blue Cross has notified physicians that it is amending sections of its Prudent Buyer Plan Participating Physician Agreement, significantly reducing the timely filing requirement for commercial and Medicare Advantage claims to 90 days from the date of service.Ĭurrently, Anthem requires physicians to submit all professional claims for commercial and Medicare Advantage plans within 365 days of the date of service.
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