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Balance Billing

BCBSNC Corporate Medical Policy (CMP)

     - Chiropractic

     - DME Vendors

     - EMG/NERVE 

       CONDUCTION

     - VAD

     - Orthotics

     - Spinal Manipulation

       under Anesthesia

Chief Complaint

CIGNA HealthCare Corporate Medical Policy (CMP)

Claims/HNS Payment Protocols

Clinical Examinations/ Re-Examinations

Chiropractic Manipulative Therapies

Coding (ICD, CPT, HCPCS)

Confidentiality of Health Care Records

Co-payment/Co-insurance/Deductibles

Covered Services

Diagnostic Impression

DME Services

Documentation Requirements for the Healthcare Record

Electrodes

Evaluation & Management Services (E/M)

Financial Hardship

Frequency of Visits

Group Practices

HNS Credentialing Policies & Procedures

Informed Consent

Insurance ID Cards

Locum Tenens Billing

Maintenance & Supportive Care

Medical Necessity

Modalities/Therapies

NC Board of Examiners Guidelines

Nerve Conduction/EMG

Non-Covered Services

Notifications to HNS

Patient Education & Instruction

Prescribing Drugs

Quality Improvement, Utilization Management (UM)

Radiology

Refunds/Overpayments

Requests for Patient Records

Retention of Records

Treatment of Family Members

Treatment Plans

Verifying Benefits

Waiving Co-pays, Deductibles & Co-Insurance

locum tenens billing

 

On occasion, a physician may arrange for a Locum Tenens (substitute) physician to see patients if he/she is out of the office and unavailable to provide chiropractic services.

 

Other than claims reporting services by a locum tenens (substitute) provider, all claims filed to HNS contracted payors must accurately reflect the name of the provider that actually rendered services.

 

If a Locum Tenens (substitute) physician is utilized, claims reporting services provided by the locum tenens provider may be submitted under the physician’s name that has contracted with the locum tenens provider, for all covered services provided, if all of the following requirements are met:

 

  • The substitute physician is either in practice for himself/herself, part of another group practice or works solely as a locum tenens or “fill in” provider. In other words, the “substitute” physician cannot be an employee of the regular physician or have either a partnership or associate relationship with the “regular” physician.
  • The regular physician is unavailable to provide the services on the dates that the substitute physician is used (i.e. – out of the office).
  • The patient has arranged, or seeks to receive services from the regular physician.
  • The substitute physician does not provide the services over a continuous period of time, longer than 60 days.
  • The health care record properly reflects the name of the provider that rendered each service.
  • The “resident” physician must maintain thorough and accurate records indicating the name and NPI number of the substitute physician, the dates the substitute physician provided services, and the names of all patients who received services by the substitute physician.  This information must be readily available to HNS and our contracted payors.

 

Note: A physician may have reciprocal arrangements with more than one physician.

 

 


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