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FAQs – Prescription Drug Reporting

In an effort to combat high prescription drug costs, legislators included language in the Consolidated Appropriations Act, 2021, requiring group health plans to submit detailed information about prescription drug pricing and health care spending to the federal government. The submission form is known as the “RxDC report.”

Dec 06, 2022 | Blog
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Pinnacle Claims Management, Inc. Expands Management Services to its Cedar Health and Wellness Center in Santa Maria, Calif.

IRVINE, Calif. (August 1, 2022) Pinnacle Claims Management, Inc., part of the Western Growers Family of Companies (WGFC), has announced it will facilitate patient care as a managing services organization at the Cedar Health and Wellness Center located in Santa Maria, California. This comes after Pinnacle announced

Aug 01, 2022 | News

FAQs – Transparency in Coverage and Consolidated Appropriations Act [Updated 7/27/22]

In late 2020, the Departments of Health and Human Services, Labor, and Treasury released the Transparency in Coverage Final Rules (TIC) and the Consolidated Appropriations Act (CAA) was signed into law. These two initiatives provide new consumer protections as described below, and include extensive transparency reforms intended

Jul 28, 2022 | Blog

Health Plan Transparency – What is Pinnacle doing for you?

Pinnacle Claims Management Health Plan Transparency Pinnacle is committed to our clients, and as such, we actively work to ensure you receive the necessary guidance as it pertains to legislative changes in health care. There have been several provisions of the Consolidated Appropriations Act of 2021 (CAA)

Mar 07, 2022 | Blog

New COVID-19 Supplemental Paid Sick Leave Bill (AB 84) Signed by Gov. Newsom

California’s latest COVID-19 Supplemental Paid Sick Leave Bill (AB 84) was signed into law on February 9, 2022 by Governor Newsom. Details of this new legislation are set out below. Employee Use of COVID-related Supplemental Paid Sick Leave (SPSL) SPSL is available for employees unable to work

Feb 11, 2022 | News

COVID-19 UPDATE: Coverage for At-Home COVID-19 Tests

On January 10, 2022, the Biden Administration announced that, beginning January 15, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to

Jan 17, 2022 | Blog

UPDATE – Consolidated Appropriations Act

On December 27, 2020, President Trump signed Consolidated Appropriations Act, 2021 (“Act”). The voluminous appropriations and COVID-19 relief package also includes the most significant health care legislation since the Affordable Care Act, addressing balancing billing and cost transparency, as well as extending the COVID-related FSA relief measures

Nov 29, 2021 | News

Deferral of Enforcement of Transparency Rules

Introduction In October 2020, the Departments of Health and Human Services, Labor, and Treasury (collectively referred to as the “Departments”) released the Transparency in Coverage Final Rules (TIC) requiring, among other things, that non-grandfathered health plans disclose, on a public website, three machine-readable files disclosing health care

Aug 30, 2021 | News

Anthem Blue Cross and Dignity Health (“Dignity”) Contract Update

To our valued clients: We are pleased to announce that Anthem Blue Cross (“Anthem”) and Dignity Health (“Dignity”) have reached a new contract agreement that returns Dignity facilities to the Anthem network. The agreement is retroactive to July 15, 2021, and any care provided and received through

Aug 17, 2021 | News
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