• Employer groups are notified of your participating provider status as directories and web sites are updated, but these updates are often done quarterly or annually. Immediately informing your patients and local employers of your participating provider status with each CNC contract can be a great practice builder!

• Always obtain a copy of the patient's most current insurance ID card at each and every visit and make sure any changes are noted in your computer software system. 

• Look for any change in ID including alpha prefix and plan name.  This is especially important now as plans are changing ID#’s from a social security number to a unique ID# for privacy reasons.   Remember to enter the member’s complete ID# on the HCFA 1500 exactly as it appears on the ID card. Be sure to include any alpha prefix as well as any suffix that is listed with the member’s ID.

• CNC providers must obtain a new (current) insurance card each year to assure that you have the current, correct insurance information in your practice management software system.
• We strongly recommend that you obtain a copy of the patient’s insurance ID card at every visit! Please remember that insurance plans renew all through the year, not just in January, and changes may occur at any time throughout the year.
• Additionally, patient's can change insurance companies at any time and obtaining a copy of thier current card at each visit is the best way to assure that the patient has an insurance plan that processes through CNC!  (Alternatively, you should always ask at every visit, if there has been any change to their health insurance coverage.)

• Always verify benefits for every patient but please remember that the information you receive from a payor phone representative does not take precedence over any payor corporate medical policy for chiropractic so for any services other than manipulations, E/M codes, spinal and extraspinal radiology codes, and the most common therapies, please contact your CNC Provider Rep to assist you with determining if the service is appropriate and consistent with payor corporate medical policy for chiropractic.

• Chiropractic benefits vary from plan to plan and some plans have no chiropractic benefits.  When verifying benefits, always determine if the member has a co-payment or deductible and if there are any chiropractic limitations to the member’s plan.  Please remember YOU CANNOT WAIVE CO-PAYS.  WAIVING CO-PAYS IS A VIOLATION OF YOUR CNC contract and can result in termination of your status as a CNC Participating Provider.

• If you are providing services that are not routinely provided by chiropractors, (such as acupuncture) or that are not listed on the CNC fee schedules, always contact CNC for clarification regarding the appropriateness of billing for such services before providing these services.
• All services are subject to contracted payors Corporate Medical Policies, which can be found on each payor's website. 

• All claims must be submitted electronically to CNC via Chirotrack  (Exception:  secondary claims and claims with attachments)  Any such paper claims must be submitted to the following address:

• If computer billing, AND USING WINDOWED ENVELOPES TO MAIL CLAIMS, you must change the address of EACH INSURANCE COMPANY shown on your list of CNC contracts to the CNC address listed below, so that the CNC address prints on  the top of your HCFA 1500.

• Make sure new staff members carefully review the manual and all CNC instructions and to contact your CNC Provider Rep with any questions.  Click here to view CNC Provider Manual.

• Notification of changes from CNC. 

• CNC will notify you of any important changes regarding CNC policies or procedures or information regarding our contracted payors via email notification, updates to the "WHAT'S NEW" section of this website, by notifications enclosed with your CNC remittance packet.  Please review all such information carefully and make sure all appropriate staff members are made aware of these changes.

• Complete your master CNC Fax Inquiry Form

• This form should be used for all requests to trace claims or for assistance with review of an EOB/NOP.  Take time to complete this form with your provider name, phone and fax number before making copies. This will save you valuable time in the future.

• Review your Quick Reference Guide for each Insurance plan for contract specific information.

• Each contract has specific requirements unique to the claims payor. Take the time to familiarize yourself with each contract!

• Review the “sample” HCFA 1500 form for each contract.  

• Each contract has specific requirements for proper claim submission so pay careful attention to the sample HCFA 1500
  for each contract.

• Ensure that all EOB’s sent to you with your CNC remittance are routinely filed in your office for easy access!  (Should you have to resubmit a claim, you will need to attach a copy of the original EOB.) 

• You are REQUIRED to keep ALL EOB’s included with your CNC remittances and will need easy access to them if you resubmit a claim. 

• Claims must be submitted electronically except for secondary and claims with attachments

• For paper claims, all Information must be properly aligned within each HCFA box for scanning purposes. 

• Date formats must be precisely followed for scanning purposes, (ex: mm/dd/yy). 
• Boxes 5 and 7 must be completed.  Same is not acceptable.

• When completing the HCFA 1500, if you are unsure about any information relating to the patients insurance card, ALWAYS staple a copy of the front and back of the patient’s ID card to your claim form before sending to CNC.

• If the patient is a NEW patient to your practice, always attach a copy of the front and the back of the insurance card to the HCFA 1500, the first time you submit a claim to CNC.    

• If there has been any CHANGE in your patient’s insurance information, always attach a complete copy of the front and the back of the insurance card to the HCFA 1500, the first time you submit a claim after the change in their insurance information.  

• Do not hand write on the claim. Claims must be typed or computer generated.

• Claims must be filed with the patient’s and insured’s complete legal names. Do not use abbreviations or nicknames.

• The claim must be identified by the CNC contract name in the address section at the top of the HCFA form. (CNC/BCBS is an acceptable format.)  Be sure that you put the CNC address here, not the address of the insurance company.

• The complete member ID number must appear in box 1A, exactly as it appears on the member ID card, including alpha prefix and SUFFIX, if applicable.

• Correct date of birth must be on all claims.

• Always make sure that the “relationship to Insured” in box 6 on the HCFA is correctly marked with either self, spouse or child. OTHER is not acceptable.

• If unsure about what to put in box 11, 11a, 11b of the HCFA 1500, use your CNC Fax Form and fax this form, together with a copy of the front and back of the patient’s ID card, to CNC.  We will gladly fax you the correct information.

• Box 4 must always be completed with the insured's name.  Same is not acceptable.

• Different years for dates of service must be submitted on separate HCFA forms.

• Total charges must always be in box #28 and #30.

• No more than 6 services may be listed on any HCFA 1500.  

• Box 11, 11B must be completed and box 11C must contain the plan name, such as Blue Options or BCBSNC Select. ( CNC and Major Medical are not plan names and are not acceptable!)

• When filing a primary diagnosis code between 800.00 and 999.00, or if the claim is accident related, the correct date of onset must appear in box 14 of the claim form.

• The most current ICD-9 and CPT-4 coding must be used.

• All equipment and supplies must be filed using the correct HCPCS code (many DME services are not covered so please always check with your CNC Provider Rep for clarification.

• If filing BCBSNC, claims must include your individual BCBSNC provider ID number in box 24K of the HCFA form, and your BCBSNC group ID number in box 33, if applicable.

• Make certain that provider’s correct, legal name appears in box 31. The name should be computer generated or typed so that it is clearly legible.  (“Signature on file” is not acceptable!)

• Box #32 must contain the provider’s physical address.

• Claims must be submitted within 30 days of date of service.

• If submitting a corrected claim, always staple the appropriate EOB directly to the claim form and submit to CNC.

• If attaching an EOB or NOP, always staple it to your HCFA 1500.

• CNC providers are required to file for secondary coverage for all CNC contracts.  All SUCH CLAIMS MUST BE SEND DIRECTLY TO CNC.             When filing claims for members with secondary coverage, always              complete boxes 11d, as well as boxes 9a-d of the HCFA.  These boxes must be completed on each HCFA 1500, when filing with BOTH the primary and secondary carriers.  When filing for secondary coverage, you must first attach (staple) a copy of the EOB from the primary carrier to the HCFA and send directly to CNC.

• If you are a North Carolina provider filing BCBS as secondary coverage to Medicare, you must generate a new HCFA 1500, complete boxes 11d and 9a-d, attach a copy of the primary EOB, and staple it to the claim form and submit to CNC.  Medicare crossover to BCBSNC will not result in payment by the secondary carrier for BCBSNC CNC contracts.  Claims with BCBSNC as secondary must be sent directly to CNC.

• If CNC returns a claim to you for correction with a CNC Claims Return Form, please make the correction and staple this form to your corrected HCFA 1500 and return BOTH to CNC.

• Resubmit ALL corrected/lost/missing claims through CNC.

• If you receive a request for additional information on a specific patient from the insurance company or payor, you should return the requested information immediately. Always return the information to the entity that requested it, not to CNC.  (These claims are placed “on hold” by the payor and will not be processed until the information has been provided.)

• Refer to your CNC Fee schedules to confirm allowable amounts and CPT codes.  (The hard copy of your CNC Provider Manual contains your current fee schedules and new fee schedules are sent to you automatically if there are any changes.)

Waiving Co-payments, Deductibles and Coinsurance

It is unlawful to waive co-payments, deductibles, coinsurances, or other patient responsibility payments and is specifically prohibited by our contracted managed care partners.

This includes accepting a "lower" co-payment amount than the amount indicated on the member's subscriber ID card, waiving co-payments including for services deemed “professional courtesy” and TWIP (take what insurance pays).

Absent true financial hardship (with complete, current, supporting, documented evidence of such hardship maintained in the patient’s health record), the full amount of the co-pay as well as ALL co-payments, deductibles and coinsurance due and owed must be collected by all network providers for every patient visit.

For CNC Contracts:
Failure to consistently comply for individuals covered by a CNC contracted payor is in violation of the policies of our contracted payors and may result in the termination of your status as a CNC participating provider.

For Medicare:
Failure to comply for individuals covered by Medicare is a violation of the Federal False Claims Act,
Federal Anti-Kickback Statute, and the Federal and State Insurance Fraud Laws. Failure to comply may
result in civil money penalties in accordance with the new provision section 1128 A(a)(5) of the Health
Insurance Portability and Accountability Act of 1996 [section 231(h) (HIPAA).

 

• No money is collected at the time of service unless there is a co-payment and/or deductible amount stated on the ID card. Some plans only require a co-payment, while others may have a deductible and co-insurance. Always ask whether the member’s plan has a co-payment or deductible when verifying benefits.  Remember, you cannot waive co-pays!

• (FOR NORTH CAROLINA PROVIDERS)
  As a result of the new legislation, co-payments for chiropractic visits will be changing from the SPECIALIST CO-PAYMENT to the PRIMARY CARE PROVIDER (PCP) CO-PAYMENT.  The co-payments will change from March 1, 2006 through March 1, 2007, from the specialist to the PCP co-payment, AS EACH MEMBER’S PLAN RENEWS. By March 1, 2007, all plans will have renewed and the correct co-payment will be the “primary care co-payment.” Please remember that plans renew throughout the year, not just in January!

• Instructions for billing for non-covered services vary based on the insurance plan. Refer to your QUICK REFERENCE GUIDES for specific information for each plan.

• Generate a new HCFA 1500 for that date of service
• Staple the appropriate EOB to the HCFA
• Circle the Patient’s name, date of service and CPT code that is in question
• Attach a copy of the patient’s ID card
• Submit to CNC

              We will resubmit the claim to the payor for correction.

• Checks are sent to providers on the 10th, 20th and 30th (or next business day) of each month.

• Always post ALL of your CNC checks to your patients accounts BEFORE SUBMITTING REQUESTS FOR CLAIMS TRACING!

• The CNC administrative fee should never be posted to the patient’s account.  Always post the “paid” amount shown on your EOB when posting to each patient’s account.

•  Should you receive a payment for a member that is not your patient, use your CNC Fax Inquiry Form and fax a copy of the Remit Summary, a copy of the EOB (circle the patient’s name) and CNC will adjust on your next check.