8 recent payer-provider disputes, resolutions

Becker's Hospital Review reported these eight contract resolutions and dissolutions between payers and providers since July 20, beginning with the most recent.

1. Montefiore Health System, Aetna may end contract in 1 month
Bronx, N.Y.-based Montefiore Health System may no longer be a part of Aetna's provider network if the organizations can't resolve a contract dispute before a Sept. 8 deadline.

2. UPMC, Aetna extend contract through 2021
Pittsburgh-based UPMC and Aetna inked a new agreement to ensure the health insurer's commercial and Medicare Advantage members will remain in network with UPMC facilities and physicians, the companies said Aug. 2. 

3. U of Colorado Hospital, School of Medicine providers no longer accepting UnitedHealthcare MA patients
UnitedHealthcare Medicare Advantage members can no longer access providers with the Aurora-based UCHealth University of Colorado Hospital and the University of Colorado School of Medicine.

4. Texas pediatricians stop accepting managed Medicaid members, citing payment concerns
Several pediatric specialists in Austin, Texas, have notified managed care Medicaid members they cannot access services, claiming health insurers are failing to adequately reimburse them.

5. Idaho hospital's ER physicians out of network with state's largest insurers
Pocatello, Idaho-based Portneuf Medical Center's emergency room physicians are out of network with the state's two largest health insurers after the ER physicians reorganized under a new group.

6. UnitedHealth, Northwestern's 1,200-physician group may split by year's end
Chicago-based Northwestern Medical Group may no longer be a part of UnitedHealthcare's network if an agreement between the two organizations expires without resolution Jan. 1, according to a notice on Northwestern's website.

7. 560-member New York medical group expands risk-based contracts with Aetna, Anthem, WellCare
CareMount Medical Group, a 560-physician group in Chappaqua, N.Y., inked risk-based agreements with three Medicare Advantage health insurers: Aetna, Anthem and WellCare.

8. Highmark Medicare Advantage members to go out of network with UPMC in June 2019
Thousands of Highmark Medicare Advantage members will lose in-network access to Pittsburgh-based UPMC a year earlier than expected.

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