 providers frequently asked questions
View answers by clicking on questions listed below.
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1. How do I become a CNC provider?
If you are interested in joining our network, please call the CNC office at (877) 426-2411 ext 2 to request an application. We will be happy to mail you an application package right away.
Back To Questions 
2. May I download the application online?
Due to the sensitive nature of the application process, our application package is not available online. However, we will promptly mail an application to you at your request.
Back To Questions
3. Once I submit an application to CNC, will I be a participating provider with CNC?
No, you will not be a participating provider until the credentialing process has been completed and you have received written notification of the decision by the Credentialing Committee. If accepted, this letter will inform you of the effective date of your participation in our network. From that date forward, you will be considered an in-network provider. The credentialing process takes about 4 to 6 weeks.
Back To Questions
4. What is the credentialing process?
CNC strictly adheres to both URAC and NCQA guidelines for credentialing. Our providers are subject to credentialing criteria that examine education, certification, licensure, practice history, criminal history, malpractice history, 24-hour practice coverage and geoaccess needs. CNC participating providers must be recredentialed every three years.
Back To Questions
5. How long does the credentialing process take?
The credentialing process may take 4 to 6 weeks from the time we receive your completed application at CNC. We are often able to complete the process in less time. The CNC Credentialing Committee meets the last week of each month. In general, if CNC receives a completed application by the last business day of the month, the file may be presented to the Credentialing Committee by the end of the following month.
Back To Questions
6. When can I begin to see patients as a CNC participating provider?
Once you receive written notification from the CNC Credentialing Committee that your application has been approved, you may begin seeing patients as a CNC “in-network” provider.
Back To Questions
7. Can you make my effective participation date retroactive?
No, the effective date stated in your letter from CNC is the effective date of your participation in our network and is not retroactive.
Back To Questions
8. What is the first thing I should do after I am notified that I am a CNC provider?
You and your staff members should first thoroughly review the CNC Provider Instruction Manual and become familiar with all CNC and CNC payor policies. Also, become familiar with our billing guidelines and the important information regarding claims filing through CNC. This should be done prior to providing any chiropractic services to members with insurance contracts through CNC.
Back To Questions
9. Once I receive written confirmation that I am in the network, will CNC contact me to help me get started?
Yes, approximately 5 business days after you have received written notification that you are a CNC participating provider, you will receive a call from your personal CNC Provider Representative. She will call you to introduce herself and to go over important information with you regarding your new status as a CNC participating provider.
After you have spoken with your CNC Provider Rep, your billing staff will be contacted by a CNC ChiroTrack Representative to assist your office in registration and testing for submitting your claims electronically to CNC.
Back To Questions
10. Is there a waiting period for a new provider’s claims to be processed?
Once a new provider has been credentialed with CNC, there are two processes that must be completed prior to submitting claims.
First, CNC must forward your credentialing information to our managed care partners so this information can be loaded into their systems. This process usually takes approximately 2 weeks.
Second, CNC requires that all primary claims are filed electronically to CNC, so we must register you to send your claims to CNC via ChiroTrack, our electronic claims processing system. A CNC ChiroTrack Representative will contact you shortly after you have been credentialed to get started with your ChiroTrack testing. Testing may take 2 to 3 weeks, and once completed, a ChiroTrack Rep will contact you to start submitting your claims.
When the managed care partners have confirmed that you have been loaded into their systems, and your ChiroTrack testing has been completed and you are ready to send your claims electronically to CNC, you will be notified by a CNC Representative that you may start submitting claims. While there is a slight delay in the filing of your claims immediately after being accepted as a CNC Provider, please remember that during this time, you are an “in-network” participating provider with CNC.
Back To Questions
11. I have just been notified that I am now a CNC provider but when I call the insurance companies, I am told that I am not listed in their system as a participating provider. Why does this occur?
It takes insurance companies approximately 2 weeks to get their systems updated with information on newly credentialed providers. During which time, you may find that certain insurance companies cannot verify you are a participating provider. This may occur until their systems have been updated with your information. You are a participating provider as of the effective date stated in the letter you received from CNC. All claims submitted after your effective date will be processed as “in-network” claims, once the insurance companies have updated their systems.
Additionally, our managed care partners have CNC participating providers listed under the CNC master tax number (EIN) or NPI number. When calling to verify benefits or check the status of a claim, you will need to use the CNC EIN or NPI number rather than your individual EIN or NPI. Please contact your CNC Provider Rep and she will assist you with this information.
Back To Questions
12. What is the CNC master tax number (EIN)?
The CNC master tax number (EIN) is 56-1971088. Our managed care partners have CNC participating providers listed under this master EIN. When calling to verify benefits or check the status of a claim, you will need to use this EIN, rather than your individual EIN.
SOUTH CAROLINA PROVIDERS:
Select Health of South Carolina uses the CNC master tax number (EIN) (56-1971088) to identify participating providers. Always use the CNC master EIN when contacting Select Health of South Carolina about benefits, eligibility or other issues.
Back To Questions
13. How long does it take my name to appear in the directories and on the web sites of the insurance companies?
Web sites are usually updated within 6 to 8 weeks of the credentialing date. Directories are updated at various times during the year; your name and practice information will be listed in the next published directory. Consider sending a letter to your patients and local employers now, informing them of your “Participating Provider” status with each of the insurance plans on your list of CNC Contracts.
Back To Questions
14. Does CNC have a provider manual?
Yes. As soon as you receive your written notification that you have been accepted as a CNC participating provider, you and your staff should thoroughly review the CNC Provider Instruction Manual. The CNC Provider Instruction Manual includes important payor and CNC policies that must be followed by all network providers, and includes important information about claims filing, contract information, and much more. You may download the CNC Provider Instruction Manual from the web site at anytime. Please click here for the CNC Provider Instruction Manual.
Back To Questions
15. Do I call CNC to verify patient eligibility and benefits?
No, CNC cannot verify eligibility or benefits because we do not have access to the information about your patient’s insurance plan. You should call the member’s insurance company or utilize their web sites to verify benefits. However, we caution all providers to remember that corporate medical policies supersedes information given to you by payor phone representatives when verifying benefits. We urge you to first check the Payor Corporate Medical Policies, (found in the Practice Protection Plan) or contact your CNC Provider Rep to determine if services are consistent with payor corporate medical policies, prior to providing care.
Back To Questions
16. How do I know what fees are paid by each insurance plan?
The CNC Fee Schedules can be found on the secure section of this web site. If you have forgotten your unique username and password needed to access this secure section, please contact your CNC Provider Rep for assistance.
Back To Questions
17. If the CPT code is listed on the CNC Fee Schedule, does this mean it is a covered service for all of my CNC patients?
No. The fees listed next to the CPT codes indicate the amount that you should receive, subject to co-payments, co-insurance and deductibles, provided the service is a covered chiropractic benefit under the member’s health plan and the member is eligible for benefits on the date the service was provided.
Back To Questions
18. How often do we receive payments from CNC?
CNC issues bulk provider payments on the 10th, 20th and 30th (or next business day) of each month.
Back To Questions
19. Does CNC have a newsletter?
Yes. Our quarterly newsletter, the CNConnector is sent via email to all network providers and is also posted on our web site. Please click here for the current issue.
Back To Questions
20. How do I notify CNC of any changes in my practice information?
Please use your CNC Provider Change Form to notify CNC of any changes and attach additional pages as needed. Please indicate the effective date of each change. Your contract with CNC requires that you notify CNC immediately if there is ANY change of practice information such as:
Address
Addition of Satellite Office
Phone/Fax Number
Tax Identification (requires updated, completed W-9 form)
Billing Company (if applicable)
Practice Name (requires updated, completed W-9 form)
Additions or deletions of providers in the practice
Any change to the status of your chiropractic license
Any pending or settled malpractice claim
Any Medicare or Medicaid sanction
DO NOT SEND NOTIFICATION OF ANY CHANGES DIRECTLY TO THE INSURANCE COMPANIES! CNC WILL NOTIFY OUR MANAGED CARE PARTNERS OF ANY CHANGES SUBMITTED TO CNC.
Back To Questions
21. I am adding another provider to my practice. How do they become credentialed with CNC?
Call your CNC Provider Rep or use the CNC Fax Form to request a credentialing application for your new physician. (Please include the new provider’s full, legal name, and the address to mail the application.) We will promptly mail an application to your new provider.
Back To Questions
22. I am leaving my current group practice and starting my own practice (and/or joining another group practice). Will I need to re-apply with CNC after I leave my current group practice?
CNC credentials providers, not practices. If you leave one group practice to join another, or open your own practice, you will not need to re-apply with CNC. However, per your CNC contract, you must immediately notify CNC of any changes to your practice information. This includes leaving your group practice and providing us with information about your new practice. Please contact your CNC Provider Rep and she can assist you with this.
Back To Questions
23. I want to open another practice in a different location. How do I inform CNC?
Use the CNC Provider Change Form and submit written notification of any changes. You will also need to complete and submit a new W9 Form for any new location. Please include the physical and billing address of the new practice, the name of the providers practicing at the new location, name of the new practice, phone and fax numbers, and the effective date that the new practice will open. We will update our systems and notify our managed care partners of your additional location. Please remember that CNC credentials providers, not practices, and opening a second location does not guarantee participation in CNC for providers practicing at the second location who are not credentialed with CNC. So, any additional providers will have to be credentialed through CNC first. Also, please remember that each CNC provider must practice a minimum of 28 hours at his/her primary location to be a participating provider with CNC.
Back To Questions
24. Can I have a non-network provider in my practice?
No. If you and another provider are practicing in a group practice, under a single EIN, or with a group NPI number, then all providers practicing within the group must be CNC participating providers, or none of the providers in the group can be CNC participating providers.
Back To Questions
25. How often do I have to be recredentialed?
Both the NCQA and URAC require participating providers to be recredentialed every 3 years and CNC often recredentials every two years.
Back To Questions
26. Will you notify me when I am due to be recredentialed?
Yes. CNC will mail out your recredentialing application at least 4 weeks prior to the expiration of your current credentialing. (Always notify CNC of any changes in your practice information so that we have accurate information in our system when it is time to recredential you.)
Back To Questions
27. What happens if I do not return the recredentialing application by the stated deadline?
Our managed care partners have delegated the credentialing and recredentialing process for all participating providers to CNC. NCQA and URAC, the organizations that dictate credentialing policy to our managed care partners, require all providers to be recredentialed every 3 years. Therefore, providers failing to recredential will be terminated from the CNC network and from all contracts with our managed care partners.
Back To Questions
28. Does CNC notify us when there is a change involving one of the CNC contracts?
Yes! CNC will promptly notify you of any changes regarding any of our managed care partners. There are four ways we notify our providers of important news and updates.
Important news and updates are promptly added to the What’s New section of this web site.
CNC sends important information via e-notices to our network providers.
Information will be sent to you via U.S. Mail and/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 tips on claims submission. Current and past issues are available for download on this web site.
Back To Questions
|
