cnc contracts

We are excited to announce that our CNC Practice Protection Plan has been added to the secure portion of our website.   This Practice Protection Plan includes important information about post-payment audits, the CNC Documentation Requirements, payor policies, and valuable coding and billing information as well as valuable forms and templates that we hope will help you protect your practice.  Please print this material and review it with your staff.  As always, if you have any questions, please contact your CNC Provider Representative.

Click here for a printable version of the CNC Contracts

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 CNC Contracts:
Failure to consistently comply for individuals covered by a CNC contracted payor*(including self funded groups who utilize a CNC contracted payor as a third party administrator) 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).

LIST OF CNC CONTRACTS

IF YOU ARE A NORTH CAROLINA PROVIDER, YOU SHOULD SEND CLAIMS FOR ALL COVERED SERVICES FOR THE FOLLOWING CNC CONTRACTS DIRECTLY TO CNC:

(This includes any self funded plans that utilize a CNC contracted payor as a third party administrator.)

MEDCOST

PRIMARY PHYSICAN CARE

CAROLINA SUMMIT

KANAWHA  

BCBSNC

including Advantage, Select, Choice, Care, Options, Blue card, Federal employee claims and MOST BCBS out-of state claims.   Effective October 1, 2007, CNC will be processing ALL NC State Employees PPO claims.

                In-state BCBSNC plans

               Options, Advantage, Select, Choice, Federal Employees and Blue Care member ID cards will clearly

               show the "SUITCASE" logo, contain the letters PPO and MUST BE SENT TO CNC!

               Blue Care member ID cards clearly show the "SUITCASE'" logo but the letters PPO WILL NOT

               appear in the suitcase.  (The suitcase is "empty"!) SEND THESE CLAIMS TO CNC!

                 Out of state BCBS plans

                 Member ID cards for these plans that contain the "SUITCASE" logo with the letters PPO INSIDE 

                 the suitcase MUST BE SENT TO CNC.

                 Out of state BCBS plans whose member ID cards contain the "suitcase" logo but WITHOUT

                 the letters PPO INSIDE THE SUITCASE are not processed by CNC and should be sent

                 directly  to  BCBSNC.  (The suitcase is "empty"!)

             Effective October 1, 2007, CNC will be processing ALL NC State Employees PPO claims.

IF YOU ARE A SOUTH CAROLINA PROVIDER, YOU SHOULD SEND CLAIMS FOR THE FOLLOWING
CNC CONTRACTS TO CNC:

CIGNA HEATLHCARE, SC (ONLY IF you are Participating provider with Cigna Heatlhcare, SC) MEDCOST
PRIMARY PHYSICIAN CARE

CAROLINA SUMMIT
KANAWHA

IF YOU ARE A VIRGINIA PROVIDER, YOU SHOULD SEND CLAIMS FOR THE FOLLOWING CNC CONTRACTS TO CNC:

MEDCOST