primary physician care quick reference guide for Chiropractic
Primary Physician Care Quick Reference Guide For Chiropractic
The Primary Physician Care (PPC) Quick Reference Guide provides information specific to PPC concerning PPC claims, PPC members, and PPC policies. The information in this section is in addition to the CNC/Payor Policies, CNC Documentation, and CNC Billing Guidelines.
The Primary Physician Care Quick Reference Guide contains the following information specific to PPC and provides you with helpful information regarding your PPC claims.
General Information
Eligibility/Benefits
Referral System
PPC ID Cards
Claims Submission
Claims Inquiries
Provider Relations
General Information
PLEASE REMEMBER: Do not send claims directly to Primary Physician Care!
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 PPC provider through CNC and our instructions for filing claims supersede information given to you by Primary Physician Care Representatives!
Primary Physician Care is an administrative company that provides a network and claims payment services for self-funded employer groups. Look for the Primary Physician Care name and/or logo on the top right corner of the card to identify members of this PPO and send all such claims directly to CNC.
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 PPC claim, please contact your CNC Provider Rep at (877) 426-2411 before calling PPC.
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Eligibility/benefits
Chiropractic benefits vary by employer group. Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Insurance Form.
- Refer to the telephone number on the member’s identification card or call (800) 446-5439 between 8:00 AM and 5:00 PM.
Referral System
- Primary Physician Care is a PPO offering direct access to members. No referral from a PCP is needed.
- When necessary to refer to another healthcare provider, referrals within the network are strongly recommended
- No referral form is needed.
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PPC ID Cards
All Primary Physician Care plans are filed through CNC. PPC provides each of their members with a single integrated member ID card that is used for all benefits: medical, dental, chiropractic, etc... Detailed benefit information including office co-pays and in-network deductibles are available on the ID card.
IMPORTANT NOTE:
Primary Physician Care has employer groups that participate with the MedCost network. 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 member is part of the Primary Physician Care PPO. In that case, PPC should appear at the top of the CMS 1500 claim form and all claims must be filed to CNC electronically through ChiroTrack®.
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 PPC must be submitted to CNC through the ChiroTrack system. Exceptions include secondary claims, corrected claims, and any claim with an attachment.
CLICK HERE for information on filing secondary claims.
CLICK HERE for information on filing corrected claims.
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 benefits.
In order for PPC claims to adjudicate quickly and accurately, please note the following information regarding claims submission specific to PPC is additional information to the CNC Billing Guidelines.
- Group or policy number must be in box 11.
- Employer name must be in box 11b.
- Primary Physician Care PPO or PPC must be in box 11c.
- When filing claims electronically, the claim must be identified as a PPC claim in the address section at the top of the CMS 1500 claim form (CNC/PPC is an acceptable format). Be sure that you put the CNC address here.
Example:
CNC/PPC
PO Box 2368
Cornelius, NC 28031
- If the PPC ID card contains the MedCost logo, the PPC claim must be filed to CNC through ChiroTrack. When filing electronically, the claim must be identified as a PPC/MedCost claim in the address section at the top of the CMS 1500 claim form using the example below:
Example: CNC/PPC/MedCost
PO Box 2368
Cornelius, NC 28031
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/PPC fee schedule to confirm allowable amounts.
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Provider Relations
Questions relating to your participation in Primary Physician Care should be directed to your CNC Provider Rep
at (877) 426-2411.
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