 what's new
Updated 08/11/08
NC Providers -
CNC's First Provider Workshop
Featuring BCBSNC's Dr. Richard Wheeler, Medical Director for Special Investigations Unit (SIU)!
Last month, one of your colleagues in the CNC network received written notification from BCBSNC that he must repay close to $500,000 as a result of a recent post-payment audit of his patient health records by BCBSNC.
It is audits such as this that led us to create the CNC Practice Protection Plan for our providers. We are committed to helping our providers protect their practices through ongoing provider education regarding proper documentation, coding and compliance. Consistent with this commitment, CNC is excited to announce our first CNC NC Provider Workshop.
This workshop will feature Dr. Richard Wheeler, the Medical Director for BCBSNC's Special Investigations Unit (SUI). Dr. Wheeler will review documentation requirements for chiropractic. Additionally, an investigator from the BCBSNC'S SI unit will also present an overview of BCBSNC's Special Investigations Unit. There will also be a "question and answer" session with both of these great speakers! Additionally, CNC will review the changes and updates to the CNC Practice Protection Plan, including important information regarding maintenance care and other important information regarding the contracted payors that you represent as participating providers. CNC will also provide information regarding the BCBSNC fee schedule as well as the new CIGNA HealthCare contract for NC providers.
This workshop will be held at the Sheraton Four Seasons Convention Center in Greensboro on Friday, September 5, from 1 - 4pm. This workshop is designed for providers but we want to encourage you to also bring your billing CA as well. Due to space limitations, we can only allow one CA from each CNC practice to attend and CA's can only attend if accompanied by the Provider.
Please take a moment and register now for this informative Provider Workshop. To register, just go to the secure portion of this website and follow the easy instructions. Space is limited so please don't delay!
We look forward to seeing you at our first CNC Provider Workshop on September 5th.
SC PROVIDERS - GREAT NEWS!
Important News for pre- 1995 Sherman College Graduates-
For the past 4 years, on behalf of pre-1995 Sherman College graduates, CNC has worked diligently with CIGNA in an effort to allow these providers to be participating providers with CIGNA HealthCare. We are very pleased to inform you that CIGNA has now agreed to allow CNC to accept applications from All South Carolina providers! This means that ALL pre-1995 Sherman graduates are now eligible to be participating providers for CIGNA Healthcare! For those CNC providers that graduated from Sherman College prior to 1995, you will be now be CIGNA Participating Providers, effective September 1, 2008. Your names will be added to the CIGNA website listing for “in-network” providers and also will be included in provider directories.
2009 CE SEMINAR (SAVE THE DATES!)
The 2009 CE Seminar will again be held at the 4 Seasons Convention Center in Greensboro, NC on March 13, 14, 15, 2009. Please mark your calendars now to assure that you don't miss our great Free CE from CNC Seminar! (We will be announcing speakers soon!)
07/30/08
SC PROVIDERS - IMPORTANT CIGNA Update
CIGNA HealthCare has advised us that their internal claims processing problems have been resolved! Yesterday, CNC transmitted all CIGNA claims that we had been holding since July 15 so that all your claims sent to CNC since that date should begin processing immediately.
Additionally, so that you do not have to submit corrected claims for those claims that were already improperly denied, CIGNA is reprocessing all of the claims that had previously denied for the following reason: "We are unable to process this claim. The provider must submit this claim directly to the appropriate delegated partner for processing." All those claims are being reprocessed by CIGNA as quickly as possible!
07/26/08
CIGNA HealthCare News:
“CIGNA HealthCare is pleased to announce that the CIGNA HealthCare contract for chiropractic services for North Carolina has been awarded to Chiropractic Network of the Carolinas. CIGNA HealthCare of South Carolina has also renewed their contract with Chiropractic Network of the Carolinas for South Carolina. This decision was based on many factors including CNC’s many years of successful network and utilization management. CIGNA HealthCare is also pleased to announce that CNC is accepting applications from ALL SC chiropractic providers in order to allow improved access to chiropractic care for our members. We look forward to continuing our long and successful relationship with Chiropractic Network of the Carolinas and believe that together we can provide access to excellent, cost effective chiropractic care to CIGNA HealthCare participants in both North and South Carolina.”
Mr. James Beskid, Director – CIGNA HealthCare Contracting
The effective date of the CNC/CIGNA HealthCare Intermediary Agreement for chiropractic services in North Carolina is October 1, 2008.
The effective date of the CNC/CIGNA HealthCare Intermediary Agreement for chiropractic services in South Carolinas is September 1, 2008.
Dry Hydrotherapy
Please remember that you should be reporting CPT code 97124 (massage) for Dry Hydrotherapy. Please do not report CPT code 97022 (whirlpool) for dry hydrotherapy.
"Unlisted Modality" Codes -
Just a reminder that any CPT/HCPCS codes for unlisted services, unlisted modalities, unlisted DME, including but not limited to CPT codes 97039, 97139, 99199, 97799 cannot be billed through CNC. As of July 1, claims containing these codes will have to be returned to your office for correction. If you are unsure about which CPT code to use in place of one of these codes or If you need assistance with determining the proper CPT code for a particular service or procedure, please contact your CNC Provider Rep and she will be happy to assist you.
Web Seminar on Documentation and Compliance is now on the secure portion of this website!
(Approved for 4 hours of NC and SC CE credit)
For those of you who were unable to attend Dr. John Davila's seminar on Documentation and Compliance at our annual Free CE from CNC Seminar this past March, the entire seminar is now on the secure portion of this website. We urge you and your staff to watch this valuable seminar but do want to remind you that the update below regarding maintenance care is accurate as of today's date and supercedes information in the web seminar regarding maintenance care.
This information on maintenance care was not available at the time of Dr. Davila's seminar so please remember to follow the directives below regarding maintenance care.
Update on Maintenance /Supportive Care
Here is an important update from our managed care partners regarding the coverage of maintenance and supportive care by our contracted payors. Please be aware that payor representatives are often unaware of corporate medical policies so information obtained when verifying benefits does NOT supercede the following directives for chiropractic care. We also want to clarify that these are NOT policies developed by CNC; they are the policies of our contracted payors and as participating providers for these insurance plans, we are required to comply with these policies for chiropractic care.
We are very concerned about the impact of post payment audits from our contracted payors and we want to make sure that all CNC providers understand and adhere to all policies to help reduce the chances of an audit and/or minimize any payment or recoupment amounts that might result from such audits.
Here is the most current information regarding maintenance and supportive care for CNC contracted payors.:
Maintenance and supportive care is NON-COVERED for the following BCBS Members:
BCBSNC members
NC State Employee Plan members
Federal Employee Plan members
ASO (self funded) groups
HSA/HRA members (high deductible plans)
BCBS Out-of-State Plans.
Many out-of-state BCBS plans DO cover maintenance care so please contact the member's home plan to determine if maintenance care is covered. If you are told that maintenance care is covered, then you may provide maintenance care to the member and the service must be billed through CNC.
Cigna HealthCare Members - maintenance and/or supportive care is non-covered per the Cigna Corporate Medical Policy for chiropractic.
Medcost
Many Medcost payors DO cover maintenance and supportive care so please contact each payor to determine if maintenance and/or supportive care is covered. If you are told that maintenance care is covered, then you may provide maintenance care to the member and the service must be billed through CNC.
PPC
Many PPC payors DO cover maintenance and supportive care so please contact each payor to determine if maintenance and/or supportive care is covered. If you are told that maintenance care is covered, then you may provide maintenance care to the member and the service must be billed through CNC.
Kanawha
Many Kanawha payors DO cover maintenance and supportive care so please contact each payor to determine if maintenance and/or supportive care is covered. If you are told that maintenance care is covered, then you may provide maintenance care to the member and the service must be billed through CNC.
Charges for Maintenance/Supportive Care
We want to clarify that providers should have an established fee for EACH service they provide and this fee must be the same for all patients, whether the patient has insurance coverage or is a "cash" patient.
By way of example, if your fees were those listed below, then you would charge $33.00 to every patient that received a 3-4 region spinal manipulation, regardless of whether the service was maintenance or acute care.
98940 $28.00
98941 $33.00
98942 $40.00
CNC Practice Protection Plan
We are excited to announce that our CNC Practice Protection Plan has been added to the secure portion of our website. This Practice Protection Plan includes important information about CNC and payor policies, the CNC Documentation Requirements, post -payment audits, valuable coding and billing information as well as valuable forms and templates that we hope will help you protect your practice.
Please make sure you and your staff read and become familiar with this important information and as always, if you have any questions, please contact your CNC Provider Representative.
(We are in the process of updating the Practice Protection Plan shortly to include the above information regarding maintenance/supportive care.)
For NC Providers only:
IMPORTANT UPDATE REGARDING NC STATE EMPLOYEES/BCBSNC
Until recently, NC State Employees had a choice between PPO plans and the CMM (Comprehensive Major Medical plan) and during this time, all PPO claims were sent to CNC and claims for CMM members were sent directly to BCBSNC.
Effective July 1, 2008, the CMM plan will no longer be available to NC State Employees and ALL NC State Employees will be moved to the PPO product and claims for dates of service on or after July 1, 2008 must be filed through CNC.
Any claims for NC State Employees with a CMM plan for dates of service prior to July 1, 2008 should still be sent directly to BCBSNC for adjudication.
Those NC State Employees who previously had a CMM policy will be issued new member ID cards that will reflect their new PPO plan status. Please remember to obtain for new member ID cards from ALL state employees as of July 1, 2008 to assure that you have the correct subscriber ID information and be sure to change the member ID number in your practice management software. Please contact your CNC Provider Rep if you have any questions and she will be happy to assist you.
2009 CE SEMINAR (SAVE THE DATES!)
The 2009 CE Seminar will again be held at the 4 Seasons Convention Center in Greensboro, NC on March 13, 14, 15, 2009. Please mark your calendars now to assure that you don't miss our great Free CE from CNC Seminar! (We will be announcing speakers soon!)
CNC admin fee is now 9 1/2%!
For the past 36 months, CNC has had a new vision: to provide the best in network management services, both to our providers and the management care organizations that we serve. With your help, we have dramatically changed our organization. These changes have included:
Eliminating the CNC joining fee
Development of the educational and informative website
Toll free phone and fax numbers
CNC Newsletter
Regional CNC Provider Advisory Board meetings
Provider representatives
12 hrs. of free Continuing Education each year, plus 4 additional hours hours, beginning March 2008, on documentation and coding.
Excellence in Action program
Development of ChiroTrack®, our FREE electronic claims filing system
CNC has revamped and rebuilt our entire infrastructure, including the development of new software and the use of new technologies. Consistent with our 3 year strategic plan, we have been able to significantly reduce our operating expenses. All this was done to make CNC the gold standard for IPA's.
EFFECTIVE JANUARY 1ST, 2008, the CNC admin fee will be reduced to
9 1/2 % ! We are so pleased to be able to provide our network physicians with this significant reduction in the admin fee. We appreciate your continued support as we work to provide the best in network management services.
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