 "all about claims" frequently asked questions
Click on a question below to view the appropriate answer.
1. Where do I send my CNC claims?
All claims for CNC contracts must be sent electronically directly to CNC.(Exceptions are secondary claims with primary EOB's attached and any other claims with attachments, such as supporting medical necessity documentation.) If sending paper claims such as these, you must send these claims directly to CNC or the claim will not be processed correctly. Please ignore ALL other directions concerning where to send claims. CNC claims that are sent directly to the insurance company will result in a denial of your claim or payment at the out-of-network rate.
Send only paper claims with attachments to:
CNC
PO Box 2368
Cornelius, NC 28031
INSTRUCTIONS FROM CNC SUPERSEDE ALL INSTRUCTIONS FROM INSURANCE COMPANIES REGARDING WHERE TO SEND CLAIMS!
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2. Why do I send my claims to CNC?
To assure our managed care partners that you are a participating provider, entitled to “in-network” benefits, your claim must be processed by CNC first. Your claims are logged into our system and then forwarded to the insurance company for payment.
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3. What claims do I send to CNC?
If you are a NORTH CAROLINA provider, you should send ALL claims for the following CNC contracts to CNC:
Blue Cross and Blue Shield of North Carolina (BCBSNC) - Advantage, Select, Choice, Care, Options, Blue Card, federal claims, and all out of state PPO claims.)
MedCost
Healthcare Savings
Primary Physician Care
Kanawha Insurance Company
Carolina Summit Healthcare
If you are a SOUTH CAROLINA provider, you should send ALL claims for the following CNC contracts to CNC:
Cigna HealthCare of South Carolina (IF you have been credentialed as a Cigna HealthCare provider)
MedCost
Health Care Savings
Primary Physician Care
Kanawha Insurance Company
Carolina Summit
If you are a VIRGINIA provider, you should send ALL claims for the following CNC contracts to CNC:
MedCost
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4. Do I send my BCBSNC state employee claims to CNC?
CNC currently only manages the NC State Employees PPO plans so claims for members whose member ID cards indicate that the member chose a PPO plan must be sent to CNC. Effective July 1, 2008, ALL NC State employees will utilize the PPO plan and as of that date, ALL claims for NC State Employees must be sent to CNC.
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5. What if I am unsure about where to send a claim?
Use your CNC Fax Form and fax a copy of the front and back of the patient’s insurance card to CNC. We will review the card and promptly fax back your answer.
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6. May I send my claims electronically to CNC?
Yes, CNC providers are required to send all claims electronically to CNC via our electronic claims filing system, CHIROTRACK. (Exception - secondary claims with primary EOB's or any claims with attachments. These claims must be sent via "paper" to CNC.
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7. Does CNC have a payor ID #?
No, CNC does not utilize Payor ID numbers.
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8. Who do I call to verify benefits?
Where and how member benefits are verified depends on the member’s insurance. Please refer to the number on the back of the member ID card for information regarding where to verify benefits. PLEASE REMEMBER THAT Payor Corporate Medical Policy for Chiropractic takes precedence over any information give you by payor representatives. For services other than standard chiropractic treatment, please contact your CNC Provider Rep. She will assist you with determining if the service is consistent with Corporate Medical Policy. (NOTE: (BCBSNC and Cigna HealthCare's Corporate Medical Policies for Chiropractic can be found on the payor websites.)
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9. Why can’t CNC verify benefits or eligibility?
CNC is not the insurance company and thus we do not have access to such information about individual members and dependents.
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10. When I call to verify benefits, I am told that I am not a participating provider. Why does this happen and what should I do?
A few insurance companies have the participating providers listed in their system under the CNC master federal tax number instead of your individual federal tax number. When calling the insurance companies, if you are told that you are not listed as a participating provider, use the CNC master tax number, rather than your tax number. (Contact your CNC Provider Rep for more information about the use of the CNC MASTER EIN NUMBER.)
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11. Does CNC determine what is paid or denied on my claims?
No, CNC makes no decisions regarding the payment or denial of your claim! CNC does not adjudicate any claims. Claims are adjudicated by the payor. If you do not understand or agree with the payor’s remark code on the EOB, (the remark code indicates the reason for the payor’s action on each CPT code.) please contact the payor directly. If you need to resubmit a CORRECTED CLAIM, you must attach the EOB/NOP to a new claim form and send this to CNC. We will resubmit to the payor for reconsideration. Please remember that CORRECTED CLAIMS, SECONDARY CLAIMS and/or any claims with attachments cannot be sent via ChiroTrack but must be sent via "paper" to CNC.
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12. How long do I have to file a claim?
CNC requires that you submit all claims within 30 days from the date of service. However, if you discover that a claim was never submitted or the insurance company states that they have not received your claim, you may file most claims up to 12 - 18 months from the date of service. Claims submitted past payor "timely filing" requirements are routinely denied by the insurance companies for “untimely filing.”
(BCBSNC reserves the right to deny claims that are submitted more than 180 days from date of service.)
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13. Why does CNC return certain claims to my office?
When CNC determines that a claim is missing necessary information or contains incomplete or inaccurate information, we return the claim to you so that you can correct it. CNC provides this service to reduce your denials and to assist you in getting your claims paid in a timely manner.
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14. If CNC returns a claim to me, what do I do after I make the proper corrections?
Staple the claims return form to the corrected claim and mail to CNC and we will process. For proper processing of your claim, it is imperative that you return the claims return form with your HCFA! PLEASE NOTE: claims returned to you from CNC should not be resubmitted as a "CORRECTED CLAIM" since it has not yet been sent to the payor. Only claims that have already been processed by the payor (and for which you have received an EOB/NOP indicating that the claim has been processed), should be marked as "corrected claims"
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15. How do I file secondary coverage?
When filing secondary coverage for any CNC contract, once you have received the EOB from the primary carrier, you should generate a new HCFA 1500 for the same date of service including all services that were shown on the original primary claim. . Staple the primary EOB to the new HCFA form, and then send to CNC. We cannot submit a claim for secondary coverage without the primary EOB. (Medicare crossover to BCBSNC will NOT result in payment of your claim! The claim must be filed through CNC. If filing secondary coverage to BCBSNC when Medicare is the primary payor, you must attach the Medicare EOB to a new HCFA and send directly to CNC.
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16. How do I submit a corrected claim?
Write “CORRECTED CLAIM” at the top of the HCFA form, staple a copy of the EOB for that date of service to the HCFA form, and send to CNC. Corrected claims cannot be processed without the appropriate EOB.
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17. When I resubmit a claim that was previously filed incorrectly, often I receive an EOB stating this is a duplicate claim! Why does this happen and what should I do?
Many insurance companies use scanners to scan your claims into their systems. These scanners check for previously submitted dates of service and often will “kick out” a claim for a date of service that is already in the system. If this occurs, you will need to regenerate a new HCFA, attach BOTH of the EOBs (the first EOB showing a denial of the original claim and the second one showing denial as a duplicate claim) and send to CNC.
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18. What if I am not sure what to put in boxes 11A, 11B, and 11C of the HCFA?
Use you CNC fax form and fax a copy of the front and back of the insurance card to CNC and we will fax back your answer. If the claim is for a MedCost member, refer to your Medcost Physician Reference guide for this information.
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19. What is the MedCost Reference Guide and how do I receive it?
The MedCost Physician Reference Guide provides listings of Medcost employer groups and payors. It contains important information needed to complete boxes 11, 11B 11C of your HCFA 1500 as well as important phone numbers for most MedCost payors. It is updated monthly by MedCost. If you would like to receive the MedCost Reference Guide, click here for instructions.
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20. When should I complete box 14 (date of current illness or injury) on HCFA 1500?
Box 14 must be completed whenever you use a diagnosis code between 800 and 999 or if any boxes within box 10 are marked “yes.”
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21. What do I put in box 24K on the HCFA form?
If your patient has BCBSNC, your must complete box 24K with your BCBSNC provider ID #. You are not required to complete box 24K for other CNC contracts.
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22. Is “signature on file” acceptable in box 31 of the HCFA form?
For paper claims, “Signature on file” is not acceptable and will result in your claim being returned for correction. The provider’s full legal name must always be in box 31 and should be computer generated or typed so that it is clearly legible.
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23. Do I have to send a copy of the insurance card with each claim?
If sending the claim as a paper claim and the patient is a NEW patient to your practice, you should attach a copy of the front and the back of the insurance card the first time you submit a claim on this new patient.
- If sending the claims as a a paper claim and there has been any change in your patient’s insurance information, you should attach a copy of the front and the back of the insurance card.
24. If I have other problems or questions about a claim, what should I do?
Use the CNC Fax Inquiry Form and fax your question or concern to CNC or contact your CNC Provider Representative.
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25. How do I know if CNC has received my claim?
FIRST, MAKE SURE THAT YOU HAVE POSTED ALL CNC REMITTANCES! If you have not received an EOB or NOP for a particular date of service, then complete the CNC Fax Inquiry Form, include the name of the patient, the ID#, name of the insurance company, and the date of service, then fax to CNC . We will research and fax back your answer.
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26. When should I check the status of a claim?
CNC requires that you post all remittances from CNC PRIOR to requesting that any claim be traced!
For BCBSNC claims, please allow 30 days from the date the claim was sent to CNC before tracing. For other insurance plans, please allow 45-60 days from the date that the claim was submitted to CNC
If you have not received an EOB/NOP or a request for additional information for a claim submitted more than 120 days ago, please contact your CNC Provider Rep to determine if CNC received your claim. Once this is determined, we will assist you with instructions for refilling the claim.
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27. Do I have to use the CNC Fax Inquiry Form to check the status of a claim?
Yes. All requests to check the status of a claim must be submitted via the CNC Fax Inquiry Form (with the exception of MedCost!) We will respond to your inquiries within 3 business days.
(MEDCOST requires the use of their own form for tracing claims and takes 7-10 days to respond. Click here to print this MedCost Claims Tracing form. Click here for Tracing Form instructions.
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28. I traced my claim with the insurance company. The insurance company stated that the claim had been paid; however, we have not received the payment/EOB yet. What do I do?
First, review all EOB’s for that patient sent to you by CNC.
If you are still unable to locate the payment, use the CNC Fax Inquiry Form, mark the appropriate box, and fax to CNC along with the required information. CNC will investigate and respond within 5 business days.
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29. Sometimes, the EOB will reflect out-of-network benefits. I am a participating provider with CNC.
Why does this happen?
Claims sent by your office DIRECTLY to the payor are routinely denied or processed at out-of-network benefits. This is the most common reason for receiving out-of-network benefits. In order for you to receive in-network benefits, CNC claims must be sent directly to CNC.
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30. What do I do if I receive “out-of-network” benefits?
First, generate a new HCFA 1500 for that date of service and mark the claim "CORRECTED CLAIM." Make a copy of the EOB showing the out-of-network payment for that date of service. Staple this copy to your new HCFA and send to CNC. We will resubmit the claim. (Be aware that this second submission often results in a denial for “duplicate” submission of a claim and can take months to be correctly processed.) ALWAYS SEND YOUR CLAIMS TO CNC, NOT THE INSURANCE COMPANY!
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31. What do I do if I receive payment for a member that is not a patient in our practice?
Please immediately fax a completed CNC Fax Inquiry Form, along with a copy of the remittance (circle patient’s name), and include a copy of the EOB. CNC will make an adjustment on your next check.
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32. How do I post the CNC admin fee?
You do not post the CNC admin fee. When posting to your patient’s account, post exactly the amount that is shown on the EOB as the “paid” amount! The admin fee should never be posted to your patient’s account.
Please contact your CNC Provider Rep and she will assist you with the proper posting of claims that are processed through CNC.
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33. How often do we receive a check from CNC?
CNC issues checks on the 10th, 20th, and 30th of each month.
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34. Does CNC notify us when there is a change involving one of the CNC contracts?
Yes! There are FOUR ways we notify our providers of important news and updates.
Email notifications to our providers
We update the What’s New section of this web site for the most current news and information.
Information may be sent to you via U.S. Mail or may be included in your CNC provider check packet.
(Always be sure to review all information in each CNC check packet.)
Our quarterly newsletter contains important news as well as helpful HCFA tips. Current and past issues are available for download through this web site.
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