"all about claims" frequently asked questions

Click on a question below to view the appropriate answer.

  1. Where do I send my CNC claims?
  2. Why do I send my claims to CNC?
  3. What claims do I send to CNC?
  4. Which BCBSNC plans are not filed through CNC?
  5. What if I am unsure where to send a claim?
  6. May I send my claims electronically to CNC?
  7. Does CNC have a payor ID number?
  8. Who do I call to verify benefits?
  9. Why can’t CNC verify benefits or eligibility?
  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?
  11. Does CNC determine what is paid or denied on my claims?
  12. How long do I have to file a claim?
  13. Why does CNC return certain claims to my office?
  14. If CNC sends me a CNC Electronic Claim Error Report or returns a claim to me with a CNC Claim Return Form, what do I do after I make the appropriate correction(s)?
  15. My software shows that I have electronically submitted a claim to CNC, but the payor has not received my claim. Where can it be?
  16. If I accidentally submit a claim file on ChiroTrack®, is there any way to stop it from going to the payors?
  17. If I receive a "BCBS Error" in ChiroTrack®, what is wrong with my claim and how do I correct it?
  18. 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?
  19. What if I am not sure what to put in boxes 11, 11b, and 11c on the CMS 1500 claim form?
  20. What is the MedCost Physician Reference Guide and how do I receive it?
  21. When should I complete box 14 (date of current illness or injury) on the CMS 1500 claim form?
  22. What do I put in box 24J on the CMS 1500 claim form?
  23. Is “Signature on file” acceptable in box 31 of the CMS 1500 claim form?
  24. What do I put in boxes 32a and 33a on the CMS 1500 claim form?
  25. If I have other problems or questions about a claim, what should I do?
  26. How do I know if CNC has received my claim?
  27. When should I check the status of a claim?
  28. Should I use the CNC Fax Inquiry Form to check the status of a claim?
  29. 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?
  30. Sometimes, the EOB will reflect out-of-network benefits. I am a participating provider with CNC. Why does this happen?
  31. What do I do if I receive “out-of-network” benefits?
  32. What do I do if I receive payment for a member who is not a patient in our practice?
  33. How do I post the CNC admin fee?
  34. How often do we receive a check from CNC?
  35. Does CNC notify us when there is a change involving one of the CNC contracts?




1. Where do I send my CNC claims?
All primary claims for CNC contracts must be sent electronically to CNC via ChiroTrack®. 

If you need to submit a paper claim, these claims must be sent using the standard CMS 1500 claim form, with any attachments, and must be sent directly to CNC or the claim will not be processed correctly. Claims that will be sent to CNC on paper CMS 1500 claim forms are as follows:

Secondary claims

Corrected claims

Any claim with an attachment

Inclusive Health claims

Kanawha claims

A few CIGNA Third Party Adminstrator claims  

Please remember to ignore ALL other directions from payor representatives 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.

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 first be processed by CNC, before being sent to the payors for adjudication. 

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3. What claims do I send to CNC?
If you are a NORTH CAROLINA provider, you should send claims to CNC for ALL covered services provided for the following CNC contracts:

Blue Cross and Blue Shield of North Carolina (BCBSNC) - All BCBS plans except North Carolina Blue Medicare and Children's Health Insurance Plan (CHIP).
CIGNA HealthCare
MedCost
Inclusive Health
Primary Physician Care
Kanawha Insurance Company

If you are a SOUTH CAROLINA provider, you should send claims to CNC for ALL covered services provided for the following CNC contracts:

CIGNA HealthCare
MedCost
Primary Physician Care
Kanawha Insurance Company
Select Health of South Carolina

If you are a VIRGINIA provider, you should send claims to CNC for ALL covered services provided for the following CNC contracts:

MedCost

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4. Which BCBSNC plans are not filed through CNC?

CNC manages ALL BCBSNC PPO plans, except the BCBSNC's Blue Medicare plans and Children’s Health Insurance Plan (CHIP). Your Blue Medicare and CHIP claims should be sent directly to BCBSNC.

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5. What if I am unsure about where to send a claim?
Use your CNC Fax Inquiry Form and fax a clear, legible 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.

Please note: Please lighten all CIGNA HealthCare ID cards prior to faxing them to CNC. Their background color blackens the entire card when faxed if not lightened first.

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6. May I send my claims electronically to CNC?
Yes, CNC providers are required to send all primary claims electronically to CNC via our electronic claims filing system, ChiroTrack®.  (Exceptions - secondary claims with primary EOB's, corrected claims, any claim with an attachment, and Inclusive Health claims.  These claims must be sent via “paper” on CMS 1500 claim forms to CNC.)

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7. Does CNC have a payor ID number?
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 phone 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 given to you by payor representatives.  Please contact your CNC Provider Rep for assistance in 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 web sites, in the CNC Provider Instruction Manual, and in the CNC Practice Protection Plan.)

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9. Why can’t CNC verify benefits or eligibility?
CNC is not the insurance company; therefore, 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? 
Insurance companies have CNC participating providers listed in their system under CNC’s federal tax number or NPI number. If you provide your own NPI or EIN, you will not be recognized as a CNC “in-network” provider.  

When calling the insurance companies, if you are told that you are not listed as a participating provider, use the CNC Federal Tax ID number or NPI number, rather than your tax number or NPI number.  (Contact your CNC Provider Rep for more information about the use of the CNC tax number and NPI 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 only by the payor.  If you do not understand or agree with a denial or with a payor’s remark code on the EOB (the remark code indicates the reason for the payor’s action on each CPT code), please contact your CNC Provider Rep for assistance.  

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12. How long do I have to file a claim?
CNC requires you submit all primary claims within 10 days from the date of service. However, if you discover that a claim was never submitted or the insurance company states they have not received your claim, you may have up to 12 - 18 months from the date of service to file a claim. When verifying patient benefits, please remember to ask the payor about their timely filing policies. 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 a claim is missing necessary information for correct adjudication OR if a payor rejects the claim back to CNC, we return the claim to you so 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. If you filed the claim electronically through ChiroTrack®, you will receive an Electronic Claim Error Report. If you filed a paper claim, you will receive a CNC Claim Return Form. Each form will note the specific error(s) on the claim submitted to CNC.

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14. If CNC sends me a CNC Electronic Claim Error Report or returns a claim to me with a CNC Claim Return Form, what do I do after I make the appropriate correction(s)?
If you receive a CNC Electronic Claim Error Report, make the necessary correction(s) and refile the claim electronically through ChiroTrack®.

If you receive a CNC Claim Return Form with your paper CMS 1500 claim form, make necessary correction(s), staple the claims return form to the corrected claim and mail the claim back to CNC and we will forward on to the payor for adjudication. For proper filing of your claim, it is imperative that you return the CNC Claims Return Form when you resubmit your claim to CNC.  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 been processed by the payor (and for which you have received an EOB/NOP indicating the claim has been processed) should be marked as “corrected claims”

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15. My software shows that I have electronically submitted a claim to CNC, but the payor has not received my claim. Where can it be?

When filing your claims electronically on ChiroTrack®, the system performs custom edits on your electronic claims and if any errors are found, they will appear after 24 hours.  It is very important to check the status of your claim file and correct any claim(s) that contain errors after the 24 hour processing time.  If a claim has an error, it is not submitted to the payor until all errors have been corrected.  If you have submitted a claim electronically to CNC, but the payor has not received it, the claim is most likely in an error status on ChiroTrack®.  It must be corrected and resubmitted electronically. Please remember to make the necessary changes in your practice management software so future claims will not error out for the same reason on ChiroTrack®.

If you have any questions about how to check the status of a batch file, please call your CNC ChiroTrack® Representative for assistance.

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16. If I accidentally submit a claim file on ChiroTrack®, is there any way to stop it from going to the payors?
No. Once the claim file has been submitted, processed, and clear of any errors, ChiroTrack® will automatically submit your clean claim(s) to the payor(s).

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17. If I receive a “BCBS Error” in ChiroTrack®, what is wrong with my claim and how do I correct it?
If you receive a “BCBS Error” for a claim in ChiroTrack®, that means BCBSNC found a discrepancy in either the patient's ID Number, Patient Name and/or the Patient Date of Birth.  Verify ALL patient information and make the appropriate corrections in order to resubmit the claim. Please remember to make the necessary changes in your practice management software so future claims will not error out for the same reason on ChiroTrack®.

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18. 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 have edits intended to prevent duplication of payments for the same dates of service. These edits check for previously submitted dates of service and often will “kick out” a claim for a date of service that is already in their system.  If this occurs, you will need to regenerate a new CMS 1500 claim form, attach BOTH of the EOBs (the first EOB showing a denial of the original claim and the second EOB showing denial as a duplicate claim) and send to CNC.  CNC will forward to the payor for proper adjudication.

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19. What if I am not sure what to put in boxes 11, 11b, and 11c on the CMS 1500 claim form?
Use your CNC Fax Inquiry Form and fax a clear, legible copy of the front and back of the insurance card to CNC and we will respond with the information you need to complete these boxes. 

For a MedCost member’s claim, refer to the MedCost Physician Reference Guide for this information.

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20. What is the MedCost Physician 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, and 11c of your CMS 1500 claim form as well as important phone numbers for most MedCost payors. It is updated monthly by MedCost.  Please click here for instructions on how to obtain the MedCost Physician Reference Guide.  It is a valuable resource.

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21. When should I complete box 14 (date of current illness or injury) on the CMS 1500 claim form?
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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22. What do I put in box 24J on the CMS 1500 claim form? 
Box 24J should contain the rendering provider's Type I NPI number.

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23. Is “Signature on file” acceptable in box 31 of the CMS 1500 claim form?
No. For paper claims, “Signature on file” is not acceptable and will result in your claim being returned for correction. Claims sent electronically on ChiroTrack® will error back for ’Physician Name.’  The provider’s full legal name must always be in box 31 and should be computer generated or typed so it is clearly legible.

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24. What do I put in boxes 32a and 33a on the CMS 1500 claim form? 
If you have a Type II NPI number, this number must be placed in both boxes 32a and 33a. If you do not have a Type II NPI number, you may use your individual Type I NPI number in these boxes.

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25. If I have other problems or questions about a claim, what should I do?
Complete the CNC Fax Inquiry Form and fax your question or concern to your CNC Provider Representative for assistance.

Please include the following information:

Patient Name
Date of Service (Please do not send a date range - note each date of service)
Insurance Plan
Patient Date of Birth
Patient ID number
Please include your specific question or details relating to the claim.


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26. How do I know if CNC has received my claim?
If you submitted the claim electronically, log in to ChiroTrack® and check the status of the claim file batches. If your claim files have no errors, you can search for the individual claim to verify it was submitted.

If you have checked ChiroTrack® and found that you have submitted the claim electronically and it has no errors OR you filed the claim to CNC on a paper CMS 1500 claim form, complete the CNC Fax Inquiry Form, and include the name of the patient, the ID#, patient date of birth, the name of the insurance company, and the date of service, then fax to CNC . We will research and respond within 3 business days.

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27. When should I check the status of a claim?

For BCBSNC claims, please allow 30 business days from the date the claim was submitted to CNC before tracing.  For other insurance plans, please allow 45-60 business days from the date the claim was submitted to CNC. Please remember to post all remittances from CNC PRIOR to requesting any claim be traced.

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 refiling the claim.

Please do not resubmit a duplicate claim until you have checked with your CNC Provider Rep to determine if you claim is pending at the payor.

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28. Should I 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. We will respond to your inquiries within 3 business days. 

Please include the following information:

Patient Name
Date of Service (Please do not send a date range - note each date of service)
Insurance Plan
Patient Date of Birth
Patient ID number

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29. 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, make sure all payments received from CNC have been posted to your patient’s accounts. 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 3 business days.

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30. 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 and avoiding this will save you time and money.  In order for you to receive in-network benefits, CNC claims must be sent directly to CNC.

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31. What do I do if I receive “out-of-network” benefits?
First, generate a new CMS 1500 claim form 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, and staple to your new CMS 1500 claim form. Please mail to CNC for processing.

(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 FOR CNC CONTRACTED PAYORS TO CNC, NOT THE INSURANCE COMPANY!

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32. What do I do if I receive payment for a member who 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 the EOB. CNC will make an adjustment on your next check.

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33. How do I post the CNC admin fee?
The admin fee should never be posted to your patient’s account.  When posting payments to your patient’s account, post exactly the amount shown on the EOB as the “paid” amount.  You do not post the CNC admin fee.  Please contact your CNC Provider Rep and we will assist you with the proper posting of claims that are processed through CNC.


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34. How often do we receive a check from CNC?
CNC issues checks on the 10th, 20th, and 30th of each month (or the next business day following these dates.)

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35. 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

The What’s New section of this web site.


Via U.S. Mail or included in your CNC provider check packet.

The CNConnector (our quarterly newsletter).

 


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