kanawha quick reference guide for chiropractic
Kanawha HealthCare Solutions (KHS) Quick Reference Guide for Chiropractic
The Kanawha HealthCare Solutions (KHS) Quick Reference Guide provides information specific to KHS concerning KHS claims, KHS members, and KHS policies. The information in this section is in addition to the CNC/Payor Policies, CNC Documentation, and CNC Billing Guidelines.
The Kanawha HealthCare Solutions Quick Reference Guide contains the following information specific to KHS and provides you with helpful information regarding your KHS claims.
General Information
Eligibility/Benefits
Referral System
Kanawha ID Cards
Claims Submission
Claims Inquiries
Provider Relations
General Information
PLEASE REMEMBER: Do not send claims directly to Kanawha Healthcare!
Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating Kanawha HealthCare Solutions provider through CNC and our instructions for filing claims supersede information given to you by Kanawha Representatives!
Kanawha HealthCare Solutions, Inc. offers members three products; EPO, POS, and PPO. Look for the Kanawha HealthCare Solutions, Inc name and/or KHS logo to identify members of this PPO, EPO, or POS.
PPO (Preferred Provider Organization plans)
EPO (Exclusive Provider Organization plans)
POS (Point of Service plans)
All claims for COVERED SERVICES provided to a beneficiary of a CNC contracted payor MUST be submitted to CNC. Participating providers who fail to submit all such claims to CNC may lose their status as an In-Network Provider.
If you have any questions about a Kanawha claim, please contact your CNC Provider Rep at (877) 426-2411 before calling Kanawha.
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Eligibility/benefits
Chiropractic benefits vary by employer group. Please be sure to ask for specific information on chiropractic benefits for each member. The POS and EPO plan require a referral from a primary care physician. The PPO plan is a direct member access plan requiring no referral. Confirm the plan type under which the member is covered when verifying benefits. Look for the Kanawha HealthCare Solutions, Inc. name and/or logo to identify members of this PPO, EPO or POS.
- Refer to the telephone number on the member’s identification card.
- Always ask if a referral from the PCP is required.
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Referral System
- Kanawha HealthCare Solutions, Inc., EPO and POS plans require a referral from the primary care physician.
- Kanawha HealthCare Solutions, Inc. PPO plan is a direct access plan and no referral from a PCP is needed.
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kanawha ID cards
All Kanawha HealthCare Solutions, Inc. (KHS) plans must be submitted to CNC. KHS is a part of many local, state, regional and national networks; therefore, ID cards may vary from patient to patient. Any member ID card with Kanawha on the ID card will be filed through CNC.
PLEASE NOTE: Kanawha HealthCare Solutions has some plans that participate with MedCost. If the member ID card has the MedCost logo, it is a MedCost claim and must be identified as a MedCost claim at the top of the CMS 1500 claim form and filed electronically to CNC through ChiroTrack. If it does not have the MedCost logo, the claim will still be filed to CNC but will need to be filed by paper on a CMS 1500 claim form.
If you are uncertain about where to file the claim, please use your CNC Fax Inquiry Form and fax a clear, legible copy of the member ID card to CNC and we will respond back to you with an answer within 24 hours.
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Claims Submission
All claims for Kanawha contracted plans must be submitted to CNC. At this time, Kanawha plans that are not a part of the MedCost network (does not have the MedCost logo on the patient ID card) must be filed to CNC on CMS 1500 claim forms and mailed to the address below.
CNC/KANAWHA
PO Box 2368
Cornelius, NC 28031
Ignore any instructions regarding where to submit claims by payor phone representatives. CNC instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying eligibility and benefits.
In order for Kanawha claims to adjudicate quickly and accurately, please note the following information regarding claim submission specific to Kanawha HeathCare Solutions is additional information to the CNC Billing Guidelines.
- Group or policy number must be in box 11.
- Employer name must be in box 11b.
- Kanawha or KHS must be in box 11c
- At this time, Kanawha HealthCare claims must be filed by paper using the CMS 1500 claim form. The claim must be identified as a Kanawha claim in the address section at the top of the CMS form (CNC/Kanawha is an acceptable format) using the example below:
Example:
CNC/Kanawha
PO Box 2368
Cornelius, NC 28031
- If the Kanawha ID card contains the MedCost logo, the Kanawha claim must be filed to CNC through ChiroTrack. When filing electronically, the claim must be identified as a Kanawha/MedCost claim in the address section at the top of the CMS 1500 claim form using the example below:
Example: CNC/Kanawha/MedCost
PO Box 2368
Cornelius, NC 28031
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Claims Inquiries
- For tracing outstanding claims (after 60 days from your billing date), complete the CNC Fax Inquiry Form and fax to CNC. Please include the patient name, date of birth, member ID number, and each date of service you would like traced.
We will gladly trace the claim for you and will respond back to you within 3 business days.
- Resubmit lost/missing claims through CNC.
- Refer to your CNC/Kanawha Fee Schedule to confirm allowable amounts.
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Provider Relations
Questions relating to your participation in Kanawha should be directed to your CNC Provider Rep
at (877) 426-2411.
IMPORTANT NOTE:
Kanawha Healthcare Solutions has plans that participate in the MedCost Program. If the ID card has the MedCost logo, it is a MedCost claim and must be identified as a Medcost claim at the top of the CMS 1500 claim form. If it does not have the MedCost logo, the claim will still be filed to CNC but will need to be filed by paper on a CMS 1500 claim form. If you are uncertain, please use your CNC Fax Inquiry Form and a fax copy of the ID card to CNC. We will review the card and fax back the correct information.
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