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April 2007

Dear Medical Group Administrator:

Have you experienced any of the following reimbursement issues with your health plan payers: bundling, downcoding, refusal to recognize modifiers, delays in payment, retrospective refund requests, failure to pay in accordance with your contract with a health plan payer? If so, you will be interested to learn that the protections provided in the multi-district litigation (MDL) settlements can help. The American Medical Association (AMA), the American Medical Group Association (AMGA) and the Medical Group Management Association (MGMA) want you to know that Aetna Inc., CIGNA Corp., Health Net Inc., Humana Inc., and WellPoint Inc. (Anthem) MDL lawsuit settlements are all effective. As a result of these settlements, the unfair practices mentioned above are prohibited.

The true value of these settlements is found in such protections going forward and can be achieved through the compliance dispute process, which allows physicians to have a neutral mediator resolve disputes with the settling health plans. You are encouraged to stay vigilant in reviewing, auditing and tracking claim payments from the settling health plans to make sure each health plan processes and pays your claims according to its settlement agreements. If you are not being paid appropriately under the health plan payer’s settlement terms, you are encouraged to file a compliance dispute. A compliance dispute that was recently filed by physicians resulted in more than $12.5 million dollars being refunded to physicians. Did you submit your eligible claims by the deadline to receive your refund? Visit www.ama-assn.org/go/settlements or www.amga.org or www.mgma.com for more information regarding the compliance dispute process. These organizations are working with the MDL compliance dispute facilitators who can assist you in filing compliance disputes free of charge.

The AMA has created informational fliers to assist you in understanding the MDL settlement and the key provisions of each individual settlement. To learn what protections these settlements provide your practice, visit www.ama-assn.org/go/settlements or www.hmosettlements.org or www.amga.org or www.mgma.com to download these complimentary fliers.


American Medical Association American Medical Group Association Medical Group Management Association

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