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January 31, 2009
The final negotiations for the new BCBSNC fee schedule were completed late Friday (January 30th) and the new fees have been loaded into the BCBSNC system! We are very pleased to report that the effective date of the new BCBSNC fee schedule is February 1, 2009! This has been a very lengthy process and we greatly appreciate your patience while we worked to improve your reimbursement.
This new fee schedule provides significant improvement to many important codes and also includes several new covered services. To assist you with understanding some of the changes to this new fee schedule, we ask that you please take a moment to read all of the information in this notice.
During this process we have worked with BCBSNC to address many chiropractic issues, but our primary objective was to significantly improve the reimbursement for the most frequently billed chiropractic codes, and specifically, the Chiropractic Manipulation Treatment (CMT) codes.
Here are the new BCBSNC fees for CMT codes:
New Fee Schedule Old Fee Schedule
98940 $27.85 98940 $19.18
98941 $33.75 98941 $25.85
98942 $40.00 98942 $33.08
98943 $22.00 98943 $20.01
Consistent with the industry norm, BCBSNC limited the fee increase to a 5% weighted overall increase from our existing fee schedule. To obtain the significant increase for the CMT codes that we were seeking, and to also assure that other frequently billed codes were significantly improved, and still remain within the 5% weighted increase parameter, many changes were necessary and concessions had to be made with certain codes.
Only a small number of codes were negatively impacted and CNC worked hard to limit those fees to those services which were not billed by the majority of our network providers, and/or services that could be eliminated with relatively small impact to the provider, and/or services that could continue to be provided at very low cost to the provider.
The complete BCBCNC fee is available on the secure portion of the CNC website, so please log on to this secure section of the website to view or print the new fee schedule.
Claims for dates of service prior to February 1, 2009 will continue to be adjudicated per the “old” fee schedule.
BCBSNC CMP Reminder
Please remember that the BCBSNC Corporate Medical Policy (CMP) IS being enforced. We cannot overstate the importance of network providers’ ongoing compliance to the CMP. Noncompliance puts you and your practice in jeopardy!
To properly comply, it is imperative that you and your staff read and become familiar with this CMP. The CMP is included in your CNC Practice Protection Plan and the Practice Protection Plan is available on the secure portion of the CNC website. You must also have a clear understanding regarding the specific BCBS plans which are governed by this CMP, as well as those that are not. (Remember, some BCBS out-of-state plans DO cover maintenance and supportive care!)
The BCBSNC CMP governs the following BCBS lines of business:
BCBS in-state PPO
NC State Employees
Federal Employee Plan
ASO (Self funded plans)
HRA/HSA plans
BCBS Out-of-State plans are NOT subject to the BCBSNC CMP. For members with out-of-state BCBS, network providers must verify benefits directly with the home plan and may bill for any chiropractic covered service that was authorized by the home plan.
Covered services NOT listed on this new fee schedule that are consistent with BCBSNC CMP may be billed by CNC providers and will be considered by BCBSNC on an individual basis.
Please remember that benefits vary based on plan design, and because a service is listed on this new fee schedule does not necessarily mean that it is a covered service for each member. You should continue to verify benefits just as you do now.
We hope you are pleased with this improved BCBS fee schedule. As always, if you have any questions, please call your CNC Provider Representative and she will be happy to assist you.
Thank you,
CNC
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