 carolina summit quick reference guide for chiropractic
Carolina Summit Quick Reference Guide For Chiropractic
General Information
Do not send claims directly to Carolina Summit Healthcare!
Ignore the claims billing address on the member ID card or given to you on the telephone when verifying benefits. You are under contract through HNS and our instructions for filing claims override information given to you by Carolina Summit Healthcare!
Carolina Summit Healthcare, Inc. is a North Carolina-based, community-owned Managed Care Organization. Summit's network of providers spans more than 48 North Carolina counties with over 36 hospitals and 5500 health care providers.
 Eligibility/Benefits/Referral
Look for the CAROLINA SUMMIT HEALTHCARE name and/or logo to identify members.
- Telephone: Refer to the number on the member’s identification card
- Chiropractic benefits may vary by employer group; ask for specific information on Chiropractic benefits. Some plans may require a referral from the primary care physician. Confirm the plan type under which the member is covered when you call to verify benefits!
- Always ask if a referral from the PCP is required.
Co-payment/Co-insurance Collection
- No money is collected at the time of service unless a specific co-payment applies to chiropractic benefits. Inquire about the co-payment amount when verifying benefits.
- Upon receipt of the EOB or remittance summary, provider may bill for any deductible or co-insurance up to the CAROLINA SUMMIT HEALTHCARE allowed amount.
- Provider may not balance bill for the discount amount on covered services.
- Non-covered services may be billed at the provider’s normal charges.
Claims Submission
Submit all claims to:
HNS
PO Box 2368
Cornelius, NC 28031
Ignore the address on the member ID card or any address given to you when verifying benefits and SEND ALL CLAIMS DIRECTLY TO HNS!
Please refer to the HNS Billing Instructions for complete information on claims submission.
- Group or policy number must be in box 11.
- Employer name must be in box 11B.
- Carolina Summit must be in box 11C
- The claim must be identified as a Carolina Summit claim in the address section at the top of the HCFA form (HNS/CS is an acceptable format. Be sure that you put the HNS address here.)
Example:
HNS/CS
PO Box 2368
Cornelius, NC 28031
- If filing Carolina Summit as secondary, always attach copy of the primary EOB from the payor, and submit this, together with a new HCFA 1500 direct to HNS.
Claims Inquiries
- For tracing overdue claims (AFTER 60 DAYS FROM DATE OF SERVICE), PLEASE COMPLETE THE HNS FAX INQUIRY FORM AND FAX THE FORM, TOGETHER WITH THE REQUESTED INFORMATION TO HNS. We will gladly trace the claim for you and respond back to you within 5 business days.
- For questions relating to payment of a claim, contact the payor shown on the remittance.
- Resubmit lost/missing claims through HNS.
- If submitting a corrected claim, you must STAPLE the appropriate EOB to the HCFA 1500 and send to HNS. Please mark “corrected” claim on the HCFA 1500.
Provider Relations
Questions relating to your participation in CAROLINA SUMMIT HEALTHCARE products should be directed to HNS at 704-895-8117, EXT 2.
|
ADL Forms 
