Journal of Urgent Care Medicine

Get Serious About Credentialing To Avoid New Penalties

Starting January 1, 2026, Elevance Health will consider “corrective measures” that penalize healthcare facilities in 11 states for using out-of-network providers to deliver care for the large insurer’s Anthem Blue Cross Blue Shield commercial health plan members. Health systems may be subject to an administrative penalty of 10% of the allowed claim amount and potential network termination, and the penalty cost cannot be passed on to the patient, according to an Anthem memo. Emergency care …

No Deal For WellNow and Excellus

WellNow urgent care and health insurer Excellus BlueCross BlueShield were not able to reach an agreement on network status prior to the ultimate expiration of the 2023 contract year, according to a news report on Syracuse.com. Both companies say they’ve engaged in good-faith discussions in an attempt to continue the contract for 2024, and Excellus reportedly offered an increase in reimbursement during negotiations. WellNow is the sole storefront provider of urgent care in central New …

Yale Study Shows ‘Surprise’ Bills Still Common After a Trip to the ED

Though much maligned in the press and the subject of legislation in a number of states, “surprise” bills are still an issue for patients after a trip to their local emergency room. In fact, a new study by Yale researchers published in the New England Journal of Medicine reveals that nearly a quarter of in-network ED visits can be followed by a bill from an out-of-network doctor. The authors considered claims for more than 2 …

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