 providers frequently asked questions
View answers by clicking on questions listed below.
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1. How do I become a CNC provider?
If you are interested in joining our network, please call the CNC office at (704) 895-8117 ext 2 to request an application! We will be happy to mail you an application package right away. Please be aware that submission of an application is not a guarantee of acceptance in our network.
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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.
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3. Is there a fee to join CNC?
No. There is no fee to join CNC. Our revenues come from the CNC administration fee, which is a percentage of the “allowable” amount, shown on your EOB’s.
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4. 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 is complete and you have notified you, IN WRITING, of the decision of 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 4-6 weeks.
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5. What is the credentialing process?
CNC strictly adheres to both URAC and NCQA guidelines for credentialing. Our providers are required to adhere to credentialing criteria that examine education, certification, licensure, practice history, criminal history, malpractice history, 24-hour practice coverage, geoaccess needs and patient satisfaction. All participating providers must be recredentialed every three years.
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6. How long does the credentialing process take?
The credentialing process may take as long as 4 to 6 weeks. We are often able to complete the process in less time. In general, if CNC receives a completed application by the 12th of the month, the file may be presented to the credentialing committee by the end of that same month. (Our credentialing committee meets the last week of each month.)
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7. How will I know if and when I am credentialed with CNC and when I am a participating provider in the network?
You will receive WRITTEN notification from CNC informing you of the credentialing committee’s decision. If accepted, your effective date of participation with CNC will be clearly stated in that notification.
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8. 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.
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9. What is the first thing I should do after I am notified that I am a CNC provider?
You and your staff members must review all information and instructions/ billing guidelines provided here on this web site. This should be done prior to providing chiropractic care for members with insurance contracts through CNC.
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10. Is there a waiting period for a new provider’s claims to be processed?
Once a new provider has been credentialed with CNC, the information is forwarded to our managed care partners to be loaded into their systems. However, until their systems have been updated with your information, your claims will be “on hold.” This process can take 4 to 8 weeks from your credentialing date. Once you are in the system, all claims that have been submitted will then be processed as “in-network” claims. Please remember that during this time, you are an “in-network” participating provider with CNC and may inform your patients of your participation status with their insurance plan.
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11. I received my acceptance letter from CNC indicating that I am a participating provider with CNC but when I call the insurance companies, I am told that I am not listed as a participating provider. Why does this occur?
It takes insurance companies up to 8 weeks to get their systems updated with information on newly credentialed providers. During that time, you may find that certain insurance companies cannot verify that you are a participating provider. This may occur only 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 would be processed as “in-network” claims, once the insurance companies have updated their systems.
Additionally, our managed care partners often have CNC participating providers listed under the CNC master tax number. (EIN) When calling to verify benefits or check the status of a claim, you may need to use this EIN rather than your individual EIN. Our master tax number is 56-1971088.
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12. 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 6-8 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.
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13. How often do I have to be recredentialed?
NCQA and URAC both require participating providers to be recredentialed every 3 years.
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14. Will you notify me when I am due to be recredentialed?
Yes. CNC will mail out your recredentialing application at least 2 weeks prior to the expiration of your current credentialing. (Always notify CNC of any changes in your practice information so that we have accurate contact information in our system.)
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15. 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.
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16. What is the CNC Patient Satisfaction Program?
As part of our credentialing and quality management programs, CNC is required to measure patient satisfaction for all participating providers each year. CNC utilizes a patient satisfaction survey, with industry standard questions, to meet this requirement. During the first quarter of each year, CNC will send each provider a summary of the results of the surveys.
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17. Do I have to participate in the program?
Yes, participation in the Patient Satisfaction Program is required for all CNC providers. CNC provides you with a CNC Survey packet with all necessary instructions and forms. CNC must receive a minimum of 50 patient surveys for each CNC provider by September 30th of each year.
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18. Our practice has more than one provider. Does each provider have to participate in the Patient Satisfaction Survey?
Yes. Because the Patient Satisfaction Survey is part of the credentialing and recredentialing process, EACH participating provider must participate in this program.
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19. May I give the survey to any of my patients?
Yes. We encourage you to ask ALL of your patients to complete the survey and mail it to CNC, not just your “CNC” patients.
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20. Will CNC notify me if I do not receive the minimum of 50 surveys?
Yes. CNC will notify you in October of each year if we have not received the minimum number of surveys. To assure that we do receive the minimum number of surveys, we recommend that you give the survey to all patients over a 3-month period. Additionally, instruct your staff to emphasize the importance of the survey to each patient! Informing the patient that the Doctor is very interested in their opinions will assure that most surveys are completed and submitted to CNC.
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21. How do I get a survey packet?
New CNC providers are sent a complete survey packet approximately 4-6 weeks after being credentialed with CNC. Existing providers needing a new survey packet should fax a written request to CNC, using the CNC Fax Form. Click here for CNC Fax Form
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22. Does CNC have a provider manual?
Yes. When you receive your written notification that you have been accepted as a CNC participating provider, you will also receive the CNC Provider Manual that includes important instructions about filing your claims, contract information as well as all CNC fee schedules.
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23. Do I call CNC to verify patient benefits?
No, CNC cannot verify benefits because we do not have information on your patient’s insurance plan. However, we urge you to contact your CNC Provider Rep to determine if services are consistent with payor corporate medical policies.
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24. 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 website. If you have forgotten your unique user name and password needed to access this secure section, please contact your CNC Provider Rep for assistance. Please remember that the fees listed in your fee schedule are not a guarantee of payment.
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25. 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 and deductibles, IF your patients’ insurance covers this CPT code and the service is consistent with payor corporate medical policy for chiropractic.
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26. Does CNC have a newsletter?
Yes. Our quarterly newsletter, the CNConnector is posted online. Please click here for the current issue.
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27. What is the CNC master tax number (EIN)?
The CNC Master tax number (EIN) is 56-1971088. Our managed care partners often have CNC participating providers listed under this master EIN. When calling to verify benefits or check the status of a claim, you may need to use this EIN, rather than your individual EIN.
SOUTH CAROLINA PROVIDERS:
CIGNA HEALTHCARE USES THE CNC MASTER TAX NUMBER (EIN) (56-1971088) TO IDENTIFY PARTICIPATING PROVIDERS. ALWAYS USE THE CNC MASTER EIN WHEN CONTACTING CIGNA HEALTHCARE ABOUT BENEFITS, ELIGIBILITY OR OTHER ISSUES.
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28. How do I notify CNC of any changes in my practice information?
Please use your CNC Fax Inquiry Form to notify CNC of any changes; 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 malpratice claim
any Medicare or Medicaid sanction
DO NOT SEND NOTIFICATION OF ANY CHANGES DIRECTLY TO THE INSURANCE COMPANIES! CNC WILL NOTIFY OUR MANAGED PARTNERS OF ANY CHANGES SUBMITTED TO CNC.
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29. I am retiring. how do I terminate my contract with CNC and our managed care partners?
Per your CNC contract, termination with CNC requires a written, 90-day advance notice of your intent to terminate. This letter must be submitted IN WRITING to CNC 90 days before the effective date of your termination and must clearly indicate the final date of your participation with CNC. Additionally, during this 90-day period you must continue to provide care to your “CNC” patients and must inform them of the effective date of your termination as a participating provider with their insurance plans.
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30. I am considering adding another provider to my practice. How do they become credentialed with CNC?
Use the CNC Fax form and request a credentialing application for your new Doctor. (Please include the new provider’s full, legal name.) We will promptly mail an application to your new provider.
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31. I want to open another practice in a different location. How do I inform CNC?
Use the CNC Fax Form and submit a written notification of any changes. Attach W9’s and any additional sheets as needed.
Please include the physical and billing address of the new practice, the name of the providers practicing at the new location, name of the practice, phone and fax numbers, completed W9, (if applicable) and the effective date of the new practice. We will update our system 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. Such providers will have to be credentialed through CNC first. Also, please remember that each CNC provider must practice a minimun of 28 hours at his/her primary location to be a participating provider with CNC.
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32. How often do we receive a check from CNC?
CNC Provider checks are issued on the 10th, 20th and 30th (or last business day) of each month, effective August, 2006.
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33. 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.
CNC email 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.
Always check the What’s New section of this web site for current news and information.
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