CalCPA ProtectPlus » hospital

Health Term: Hospital

CalCPA ProtectPlus — Wed, 11 Aug 2010 18:00:31 +0000

Hospital is a facility which provides diagnosis, treatment and care of persons who need acute inpatient hospital care under the supervision of physicians. It must be licensed as a general acute care hospital according to state and local laws. It must also be registered as a general hospital by the American Hospital Association and meet accreditation standards of the Joint Commission on Accreditation of Health Care Organizations.

For the limited purpose of inpatient care for the acute phase of a mental or nervous disorder, severe mental disorder, or substance abuse, “hospital” also includes psychiatric health facilities.

Health Term: Contracting Hospital

CalCPA ProtectPlus — Wed, 24 Mar 2010 18:00:08 +0000

Contracting Hospital is a hospital which has a Standard Hospital Contract in effect with the claims administrator to provide care to beneficiaries. A contracting hospital is not necessarily a participating provider. A list of contracting hospitals will be sent on request.

Health Term: Participating Hospital

CalCPA ProtectPlus — Wed, 27 Jan 2010 18:00:46 +0000

Participating Hospital is a hospital which has a claims administrator’s Participating Agreement in effect with the claims administrator, as appropriate, at the time services are rendered. Participating hospitals agree to accept the negotiated rate as payment in full for covered services. Participating hospitals agree to participate in procedures established to review the utilization of hospital services. Hospital services determined to be unnecessary, according to these utilization review procedures, are not covered by the plan. A list of participating hospitals is available upon request from the plan administrator, as appropriate.

Latest Wellpoint Network Updates: ProtectPlus Members

CalCPA ProtectPlus — Tue, 23 Jun 2009 18:00:29 +0000

Hospital Facilities:

County Facility Current Status Effective Date Alternatives

Madera Children’s Hospital Central California An agreement was reached, which will be effective from 7/1/09 through 5/7/11. 6/12/2009

Humboldt Mad River Community Hospital An agreement was reached, which will be effective from 7/1/09 through 6/30/12. 7/1/2009

HMO Medical Groups:

County Medical Group – PMG/IPA site Current Status Effective Date Alternatives

Tulare Mosaic Medical Group (0WR) In Active Negotiations 8/1/2009 1. Key Medical Group (AED)

Solano Northbay Medical Group (0TL) In Active Negotiations 9/1/2009 1. Hill Physicians Medical Group / Solano(0KS) 2. Sutter Regional Medical Foundation (1CF)

Fresno Sante’ Community Physicians (0KQ) In Active Negotiations 9/1/2009 1. New Admin Site

PPO Physicians:

County Provider Specialty Current Status Effective Date

Alameda Joseph N Togba, MD Plastic Surgery Reimbursement Terminate 7/14/09

Hospital Facilities:

County Facility Current Status Effective Date Alternatives
Madera Children’s Hospital Central California: An agreement was reached, which will be effective from 7/1/09 through 5/7/11. 6/12/2009
Humboldt Mad River Community Hospital An agreement was reached, which will be effective from 7/1/09 through 6/30/12. 7/1/2009

HMO Medical Groups:

County Medical Group – PMG/IPA site Current Status Effective Date Alternatives
Tulare Mosaic Medical Group (0WR) In Active Negotiations 8/1/2009 1. Key Medical Group (AED)
Solano Northbay Medical Group (0TL) In Active Negotiations 9/1/2009 1. Hill Physicians Medical Group / Solano(0KS) 2. Sutter Regional Medical Foundation (1CF)
Fresno Sante’ Community Physicians (0KQ) In Active Negotiations 9/1/2009 1. New Admin Site

PPO Physicians:

County Provider Specialty Current Status Effective Date
Alameda Joseph N Togba, MD Plastic Surgery Reimbursement Terminate 7/14/09

News: Anthem Blue Cross – Local Negotiations

CalCPA ProtectPlus — Mon, 01 Jun 2009 04:24:58 +0000

Anthem Blue Cross is currently in active negotiations with Children’s Hospital of Central California, located in Madera county. Anthem’s contract with this provider is currently scheduled to terminate as of 6/8/09, if an agreement is not made with this facility.

Should this occur, alternative facilities that members can use in this area include Fresno Heart Hospital, St. Agnes Medical Center or Community Medical Center of Fresno.