select health of south carolina quick reference guide for chiropractic
 
Select Health of South Carolina Quick Reference Guide For Chiropractic
The Select Health of South Carolina Quick Reference Guide provides information specific to the Select Health plan, First Choice Kids, concerning Select Health claims, Select Health members, and Select Health policies. The information in this section is in addition to the CNC/Payor Policies, CNC Documentation, and CNC Billing Guidelines.
The Select Health Quick Reference Guide contains the following information specific to Select Health First Choice Kids and provides you with helpful information regarding your Select Health First Choice Kids claims.
General Information
Eligibility/Benefits
Referral System
Select Health ID Cards
Claims Submission
Claims Inquiries
Provider Relations
General Information
PLEASE REMEMBER: Do not send claims directly to Select Health!
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 Select Health of South Carolina provider through CNC and our instructions for filing claims supersede information given to you by Select Health or First Choice Kids Representatives!
Select Health of South Carolina has contracted with CNC as their chiropractic network for the State Children's Health Insurance Program (SCHIP), also known as Select Health's First Choice Kids.
First Choice Kids is a health plan that covers children whose family earns too much to qualify for Medicaid, but not enough to afford a private health insurance plan.
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 Select Health/First Choice Kids claim, please contact your CNC Provider Rep at (877) 426-2411.
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Eligibility/benefits
Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Insurance Form.
- To verify eligibility and benefits - Refer to the telephone number on the member’s identification card or call (888) 559-2020.
- Prior authorization is required for Select Health plans. To obtain prior authorization, please call (888) 559-1010.
Please note: Obtaining a prior authorization number is no guarantee of patient eligibility and benefits. You must first call to verify eligibility and benefits before obtaining a prior authorization number.
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 you are not listed as a participating provider.)
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Referral System
- No referral from a PCP is required, but Select Health prefers that patients be referred by the patient's PCP.
- If a patient was referred to you by the PCP, you must use boxes 17 and 17b on the claim form to identify the referring physician.
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Select Health ID Cards
First Choice Kids is the only Select Health plan that should be filed through CNC at this time. SCHIP and First Choice Kids program are the same plan. Select Health provides each of their members with an ID card.
If you are uncertain about where to file a 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 First Choice Kids must be submitted to CNC through the ChiroTrack® system. Exceptions include corrected claims or any claims with attachments. First Choice Kids is a single plan, and there will not be any secondary claims as a child can only have this one insurance plan.
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 Select Health claims to adjudicate quickly and accurately, please note the following information regarding claims submission specific to Select Health in addition to the CNC Billing Guidelines.
- First Choice Kids should be in box 11 (this is the group number).
- Select Health or First Choice Kids must be in box 11c.
- The prior authorization number must be in box 23.
- If you receive a referral from the PCP, box 17 must be completed.
- If you receive a referral from the PCP, box 17b must be completed.
- Even when filing the claim electronically, the claim must be identified as a Select Health claim in the address section at the top of the CMS 1500 claim form (CNC/Select Health is an acceptable format) using the example below:
Example:
CNC/Select Health
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/Select Health Fee Schedule to confirm allowable amounts if prior authorization was obtained before rendering services.
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Provider Relations
Questions relating to your participation in Select Health should be directed to your CNC Provider Rep
at (877) 426-2411.
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