what's new

07/25/09

Identity Theft – Red Flag Rules

Deadline approaches for DCs

The Federal Trade Commission (FTC), recently issued rules and guidelines aimed at detecting, preventing, and mitigation identity theft as part of the Fair and Accurate Credit Transactions Act.  These rules are known as the Red Flag Rules and the effective date for compliance to these rules is AUGUST 1, 2009.  

Because most chiropractors qualify as creditors that offer or maintain covered accounts, they will need to develop and implement an identity theft program to comply with the Red Flag Rules.  To assist our providers in complying with this new law, additional information, as well as a prototype plan was included in the 06/30/09 CNC check-cut packet you received.   We urge you to thoroughly review the information that we have sent you and to utilize this prototype plan and customize if for you individual practice.  Please be aware that this prototype plan alone is not sufficient to comply with this law.  Implementing an appropriate plan, staff training and ongoing monitoring, as well as possible program modification may be necessary to comply with this new law.

7/16/09

Important Correction for CIGNA

MISSION claims -

CIGNA HealthCare has just informed CNC that claims for Mission Employee Health Plan, which is part of the Crescent Network and administered by CIGNA HealthCare, must be filed directly to CIGNA HEALTHCARE, not through CNC.

Enrollees with the Mission Employee Health Plan can be identified by their member ID cards. These cards will either include the CRESCENT logo or just the word CRESCENT on the top of the ID card.

Please send these claims to the Cigna address on the back of the member ID card.

07/12/09

Important Cigna Announcement

CIGNA HealthCare and CNC are pleased to announce an agreement to work towards moving from a per visit payment methodology (global fee) to a fee-for-service schedule for chiropractic services for North and South Carolina with a targeted effective date of November 1, 2009. 

CIGNA and CNC are working to complete this project and CNC will provide you with the new fee schedule as soon as possible but no later than 30 days in advance of the effective date.

On behalf of CIGNA HealthCare and CNC, we thank you for your patience and look forward to providing you with a new fee-for-service fee schedule later this fall.

06/29/09

Important BCBSNC Announcement for NC Providers

Effective immediately, CNC will be managing 2 new additional BCBS products on behalf of BCBSNC.

 1. Blue Medicare Supplement Plans

All BCBSNC Blue Medicare Supplement claims should now be sent to CNC.

To help identify these Blue Medicare Supplement claims, please note the following:

• Member ID cards will include the words Blue Medicare Supplement.

• Blue Medicare Supplement plans will include the following ALPHA prefix as part of the subscriber ID number:

                           YPZJ

                           YPZW

• BCBSNC Blue Medicare Supplement plans only provide SECONDARY coverage and as with all secondary claims, cannot be sent electronically to CNC. 

•  Claims for BCBSNC Blue Medicare Supplement plans must be filed by paper to CNC via the CMS 1500 claim form with the primary EOB attached.

Important Note:  BCBSNC Medicare HMO/PPO plans, such as

Partners Medicare Advantage, should still be filed DIRECTLY to BCBSNC. 

2. All out-of-state BCBS Medicare plans

All out-of-state BCBS Medicare plans must now be filed through CNC, rather than directly to BCBSNC.

Important Note:  BCBS out-of-state secondary products must be submitted to CNC by paper with primary EOB attached. 

As always, please contact your CNC Provider Rep if you have any questions and she will be happy to assist you!

06/23/09

ALL PROVIDERS

Identity Theft – Red Flag Rules

Deadline approaches for DCs

The Federal Trade Commission (FTC), recently issued rules and guidelines aimed at detecting, preventing, and mitigation identity theft as part of the Fair and Accurate Credit Transactions Act.  These rules are known as the Red Flag Rules.  Most health care providers will have to comply with requirements of these rules by August 1, 2009.

Specifically, the Red Flag Rules require that each “creditor” that offers or maintains a “covered account” develop and implement a written identity theft prevention program.  Any health care provider, including chiropractors, that defers payment for goods or services such as by billing in arrears for treatment, will be considered a creditor according to the FTC. Consequently, most healthcare providers will fall within the Red Flag Rules broad definition of creditor simply by billing patients after rendering services.

Because most chiropractors qualify as creditors that offer or maintain covered accounts, they will need to develop and implement an identity theft program to comply with the Red Flag Rules.

To assist our providers in complying with this new law, additional information, as well as a prototype plan will be included in the 06/30/09 check-cut packet.   We urge you to thoroughly review the information that we are sending you and to utilize this prototype plan and customize if for you individual practice.  Please be aware that this prototype plan alone is not sufficient to comply with this law.  Implementing an appropriate plan, staff training and ongoing monitoring, as well as possible program modification may be necessary to comply with this new law.

6/23/09

SC Providers for Select Health of South Carolina.

Important Update - Select Health of South Carolina has two phone numbers that you must call prior to chiropractic treatment.

To verify eligibility and benefits, please call (888) 559-2020.  

Select Health has attached the CNC EIN to all CNC providers, so you MUST use

the CNC TAX ID number (56-1971088) in order to receive in-network verification. 

(If you use your own EIN when verifying eligibility and benefits, you will be told that you are not listed as a participating provider.)

To obtain a prior authorization number, please call (888) 559-1010.   This prior authorization must be obtained before you can provide any services to Select Health members and must be included on your claims for all Select Health members.

Please note: You must call for eligibility and benefits prior to calling for a prior authorization number. Obtaining a prior authorization number is no guarantee that a patient is eligible for benefits.

05/27/09

NC PROVIDERS ONLY

Update to BCBSNC Corporate Medical Policy

Dry Hydrotherapy

CNC has recently been informed by BCBSNC that Dry Hydrotherapy will no longer be a covered service for BCBSNC members.   You may bill members directly for this non-covered service, provided you first obtain a signed waiver from the member. 

Please remember that all such waivers must be maintained in the member's health care record.  

05/18/09

FREE Continuing Education

for South Carolina NETWORK Providers  

CNC is excited to announce our 2009 “Free CE from CNC” in conjunction with the South Carolina Chiropractic Association.   On your behalf, CNC will pick up the tab for half the cost of your required continuing education courses ($142.50) offered at the SCCA annual convention.

Our goal is to assist you with the costs of meeting your biannual continuing education requirements!  CNC will pay half the costs for continuing education courses offered by the SC Chiropractic Association at the annual convention in Myrtle Beach, SC.  To take advantage of this free CE, you must register with the SCCA no later than June 25th, 2009.

The SCCA is working with CNC to make this as easy as possible.  You will still register with the SCCA for the convention and the continuing education course(s) that you would like to attend.  The SCCA will bill CNC for ½ of the cost.   If you are not currently a SCCA member, please join your state association today and take advantage of all of the member benefits, including CNC’s assistance with meeting your CE requirements.  To register, please contact the SCCA at 803-772-9376 or visit their website at www.scchiropractic.org and please be sure to register prior to June 25th, 2009.

CNC encourages all chiropractors to join their state association.   However, if you are a CNC participating provider but NOT a member of your state association, on your behalf CNC will pay the SCCA the equivalent of ½ of the SCCA MEMBER cost towards your biannual CE requirements, provided the CE is through the SCCA convention and provided you register by June 25th.  Your state association serves ALL chiropractors in your state, not just the members…..so please consider joining today.

05/11/09

The Department of Health and Human Services' Office of Inspector General (OIG)has just released their 2009 report on the INAPPROPRIATE MEDICARE

PAYMENTS FOR CHIROPRACTIC SERVICES.  This report can have a tremendous impact on the number of post-payment audits for chiropractic services and CNC urges all network providers to read the following Executive Summary, copied from report:

E X E C U T I V E S U M M A R Y

In 2006, Medicare inappropriately paid $178 million (out of

$466 million) for chiropractic claims for services that medical reviewers

determined to be maintenance therapy ($157 million), miscoded

($11 million), or undocumented ($46 million). These claims represent

47 percent of all allowed chiropractic claims that met the study criteria.

Claims representing $36 million had multiple errors.

Efforts to stop payments for maintenance therapy have been largely

ineffective. CMS, carriers, and program safeguard contractors (PSC)

use a number of strategies to deter inappropriate payments for

maintenance therapy, including use of the AT modifier to indicate

active/corrective treatment, provider education, frequency-based control

edits (caps), and focused medical review. Despite these efforts, carriers

and PSCs continue to report high errors for chiropractic claims. Carrier

staff, PSC staff, and medical reviewers for this study agreed that the

AT modifier did not prevent inappropriate payments for maintenance

therapy because chiropractors continued to submit claims for

maintenance therapy with the AT modifier.

 Claims data lack initial visit dates for treatment episodes, hindering

the identification of maintenance therapy. To identify active/corrective

treatment and thereby distinguish it from maintenance therapy, it is

useful to identify the start of a new treatment episode. However, claims data do not indicate when an episode begins. Thus, we asked sampled

chiropractors and the medical reviewers to identify when an episode

began and ended. Overall, only 50 percent of all treatment episodes

remained active/corrective throughout the treatment episode. In

addition, 78 percent of those treatment episodes that became

maintenance therapy did so by the 20th visit. The Comprehensive Error

Rate Testing (CERT) paid claims error rate used by CMS is based on a

review of a single claim, which limits its ability to detect maintenance

therapy and may underestimate errors in claims for chiropractic

services.   

Chiropractors often do not comply with the Manual documentation

requirements. Separate from the undocumented claims counted as

errors above, 83 percent of chiropractic claims failed to meet one or

more of the documentation requirements. Consequently, the

appropriate use of the AT modifier could not be definitively determined

through medical review for 9 percent of sampled claims, representing

$39 million.

04/26/09

Legislative Update/NC State Employees Health Plan

After much hard work and a tremendous effort by the NCCA, SB87 which included an amendment to carve out a separate chiropractic benefit for the State Employees Health Plan was ratified last week and sent to the governor for signature.  The new chiropractic copayment for the state health plan will be $45.00 for the standard plan and $55.00 for the basic plan.  This is a huge improvement over the proposed $70.00 copayment.  On behalf of all of our network providers, CNC wishes to commend and thank the NCCA for this important accomplishment for chiropractic.

04/20/09

CE Certificates

3/21/09

BCBSNC UPDATE

(Nerve Conduction Studies and EMG’s)

Are you a Diplomate of the American Chiropractic Neurology Board (DACNB)?

If so, per BCBSNC you can now perform nerve conduction studies and EMG’s on BCBS members, provided that such services are covered by the member’s health plan.    In order to bill for nerve conduction studies and EMG’s, your name must be included on the list of certified neurologists on the ACNB website – www.acnb.org.  If you are a DACNB and your name does not appear on this website, please fax a copy of your certification to your CNC Provider Rep and contact the ACNB immediately and request that they update the website to include your name and status so that you may provide and bill for these services.

Please remember - only those certified neurologists whose names appear as having active certification with the ACNB can provide and bill for these services.

If you are NOT a DACNB and/or your name is not listed on the ACNB website as a DACNB, you cannot perform or bill for EMG’s or nerve conduction studies

for BCBSNC members whose plans are subject to the BCBSNC Corporate Medical Policy.

From the American Chiropractic Neurology Board:

The Diplomate Program in Neurology Certification awarded by the American Chiropractic Neurology Board is fully accredited by the National Commission for Certification Agencies (NCCA), the accreditation body of the National Organization for Competency Assurance (NOCA). The American Chiropractic Neurology Board is the only specialty certification agency for the Chiropractic Profession that is fully accredited by NCCA. NCCA's standards exceed the requirements set forth by the American Psychological Association and the U.S. Equal Employment Opportunity Commission. The National Organization for Competency Assurance is the leader in setting Quality Standards for Credentialing Organizations.

The purpose of the certification program of the American Chiropractic Neurology Board is to conduct certification activities in a manner that upholds standards for competent practice in the health care specialty of Chiropractic Neurology. The Board also conducts recertification designed to enhance the continued competence of the Board Certified Chiropractic Neurologist.

The population of certificants shall be Doctors of Chiropractic who have completed specialist level training in neurology from a chiropractic college, university, institution, foundation or agency whose program is approved by the continuing education committee of the Commission for the Accreditation of Graduate Education in Neurology of a minimum of 300 credit hours and who have demonstrated competency in both written and practical examinations administered by the Board in the specialty of neurology.

The Board shall administer examinations for the purpose of evaluating the candidate's proficiency in Neurology and neurological subspecialties and shall issue the credential of DIPLOMATE OF THE AMERICAN CHIROPRACTIC NEUROLOGY BOARD (DACNB) to those candidates who are successful in its Board examinations.

Reminder - CNC Advertising Policies

We want to remind all network providers regarding the CNC advertising policies. Please be aware that as with all CNC and CNC payor policies, failure to consistently adhere to these policies is a violation of the terms of your CNC Practitioner's Participation Agreement and may result in the termination of this agreement so we urge you to please review all policies carefully and please contact your CNC Provider Representative if you have any questions. 

CNC providers cannot advertise for free or reduced covered services in any manner to any member of a CNC contracted payor plan, for any services for which you normally charge a fee.

CNC providers cannot provide free or reduced covered services to any member of a CNC contracted payor plan.

Also, please remember that it is illegal to advertise for free or reduced services to members of ANY federally funded plan, including beneficiaries of Medicare, Medicaid and Federal Employees Health Plan.

CNC providers are contractually required to file claims through CNC for each and every covered service provided to ANY member of a CNC contracted payor plan.

Additionally, CNC providers cannot waive or reduce co-payments, coinsurance and deductibles for such members for any covered services provided and by offering to provide free services, providers would, in essence, be waiving any applicable copayments, deductibles and/or coinsurance.

Reminder - MedCost - Inclusive Health Contract effective 1/1/09

Please remember that the new MedCost contract with Inclusive Health begins January 1st, 2009. All chiropractic claims for Inclusive Health must be sent via paper claims, directly to CNC.  At the present time, these claims cannot be filed electronically to CNC For more information about Inclusive Health, please click here.

Annual Utilization Reviews/Excellence in Action Checks

NC Providers ONLY:

New BCBSNC Fee Schedule

The effective date for the new BCBSNC fee schedule was February 1, 2009.  The new fee schedule is now available to view or print, on the secure portion portion of this website.

Important BCBS Update

BCBSNC has announced that CNC will immediately begin processing ALL

BCBS chiropractic claims, with the exception of Blue Medicare claims

(both HMO/PPO) and BCBSNC Children's Health Insurance (CHIPS) claims.

Claims for Blue Medicare and CHIPS program will continue to be sent directly to BCBSNC.

With the exception of Blue Medicare and CHIPS claims, effective immediately, all CNC providers should now send ALL BCBS chiropractic claims to CNC.  In addition to the PPO claims that you already send to CNC, you will now need to send your costwise and out-of-state- non PPO claims to CNC.  (Your costwise and out-of-state non-PPO claims have previously been sent directly to BCBSNC for processing, rather than to CNC.)

While these out-of-state non-PPO and Costwise claims must now be filed through CNC, (and payments for these claims will be included in your CNC check cut packets), these claims will NOT be subject to the CNC fee schedule but will continue to be processed at the same fee schedule as before. Claims submitted by CNC providers for these out-of-state non-PPO and Costwise plans that are not sent through CNC will not be properly adjudicated so please make certain that your billing staff is made aware of this important change. As always, if you have any questions, please contact your CNC Provider Rep for assistance. 

BCBSNC’s Website to

Recognize Providers Certified by the NCQA

In 2009, BCBSNC provider directories (including their website directory) will attach a special designation by the names of those providers that have earned the NCQA Back ain Recognition Program Certification.  This special designation as a NCQA BPRP provider should increase steerage to those providers who have received this high recognition.   Please consider making the effort to obtain this special recognition from the NCQA!   Please contact your CNC Provider Rep for details.