what's new?

2/6/2012

NC PROVIDERS ONLY

IMPORTANT Update regarding BCBSNC bundling of Therapy and CMT codes

HNS has worked diligently to resolve the bundling issues that have been impacting payments for your services.

To prevent the bundling of CPT codes 97012 and 97124 when billed with CMT codes, you must add a  -59 modifier to these therapy codes.

To correct any bundling that has occurred with CPTs 97012 or 97124, please file corrected claims to HNS.

1/26/2012 

IMPORTANT BCBSNC NEWS

REVISED BCBS CORPORATE MEDICAL POLICIES (CMP) FOR CHIROPRACTIC

HNS has just been notified that BCBSNC has revised their corporate medical policies for chiropractic.  These new policies are effective immediately.

The new policies are now posted on this website. To access the new CMP, from the home page, please click on the Provider tab, then HNS/HNS Payor Policies, then BCBSNC CMP Chiropractic. 

1/9/2012

CIGNA Duplicate EOBs

During transition to 5010, CIGNA HealthCare's claims processing sister organization,   (Post N' Track) experienced complications and as a result of this and their efforts to assure no claims were "lost", many claims have been processed numerous times, resulting in duplicate EOBs.  Please be advised that you may receive duplicate EOBs for the same dates of service for a few weeks. CIGNA and Post N' Track regret any inconvenience this may cause you.

HNS HOLIDAY CLOSINGS

New Year's holiday

HNS will be closed Friday, December 30 and Monday, January 2. 

We will reopen on Tuesday, January 3, 2012.

12/22/11

NC and SC providers

URGENT BILLING INFORMATION

HNS is now transmitting your claims via HIPAA version 5010.

Effective immediately, for your claims to be properly adjudicated under version 5010,

if any of the four diagnoses on the claim form are 800 - 999.00, you MUST check “YES”  in one of the selections in box 10 on the claim form.

Box 10 states:

Is patient condition related to:

1. Employment
2. Auto Accident
3. Other Accident

 If you are reporting one of the 800-999 diagnoses and have not answered YES

in box 10, the payor’s system will reject the claim when the HNS 5010 file is transmitted.

To assure that your claim can be successfully transmitted to the payor please always check YES in the appropriate place in box 10 on the claim form.

12/19/11

NC PROVIDERS  BCBS ORTHOTICS UPDATE

BCBSNC has advised HNS that based on their new edits, all orthotics should now be billed as follows:

  L3020 RT

  L3020 LT

or

  L3030 RT

  L3030 LT

Per BCBS, any claims for orthotics not billed with the right (RT) and left (LT) modifiers wil be denied.

12/7/11

NC PROVIDERS

TENS UNITS UPDATE

BCBSNC has advised HNS that effective immediately, all TENS units must be billed with either a NU (new) modifier or the RR (rental) modifier.

Claims submitted for TENS units without one of these modifiers will be denied.

We want to make sure you don’t experience unnecessary delays in getting your claims paid, so please make sure any claims submitted for TENS include one of the 2 required modifiers.

11/23/11

Thanksgiving Holiday Schedule

HNS will be closed Thursday and Friday, November 24 and 25 and will reopen on Monday, November 28th. 

Happy Holidays from all of us at HNS!

11/17/11

Update on BCBS Bundling

HNS has worked diligently to resolve the bundling issue that has been impacting payments for your services.

E/M AND CMT CODES

We are pleased to report that BCBSNC will no longer bundle E/M codes when billed together with manipulation codes. 

 

Please do NOT file corrected claims for any bundling that has already occurred.

 

BCBS will internally identify those claims that adjudicated incorrectly and will reprocess those claims. It may take several weeks for this process to be completed but the claims will be correctly adjudicated. 

THERAPY CODES AND CMT CODES

We are still working with BCBS to resolve the bundling of certain therapy codes when submitted with manipulation codes and will keep you updated as we work to get this resolved.

 

Please do NOT file corrected claims for these denials.

2 NEW ISSUES -

• Orthotics
• TENS Units

 Because of the new BCBS edits deployed in October, some claims for orthotics and TENS units are being denied.  For both of these services, the remark code indicates that a new (or different) modifier is needed. BCBS intends to pay these claims when submitted with the correct modifiers.   We are working to confirm which modifiers must be billed with these services and we will notify you as soon as we have this information. 

 

Please do NOT file corrected claims for these denials.

HNS knows and understands your frustration with these issues. Be assured we are working diligently to get all of these issues corrected as quickly as possible.  BCBS regrets the inconvenience this has caused you.

11/07/11

BCBS Bundling Issue

BCBS has recently incorporated advanced CCI edits and as a result of these new edits, claims including E/M and CMT codes on the same patient for the same date of service are being bundled . Bundling is also occurring when certain therapy codes are billed together with CMT codes.  HNS is working with BCBSNC Network Management to resolve this and we will notify you as soon as we have been advised as to how to get these claims reprocessed.

CIGNA Duplicate EOBs

CIGNA HealthCare's claims processing sister organization, (Post N' Track) experienced a power loss last week and as a result of this and their efforts to assure no claims were "lost", many claims have been processed numerous times, resulting in duplicate EOBs.  Please be advised that you may receive duplicate EOBs for the same dates of service for a few weeks. CIGNA and Post N' Track regret any inconvenience this may cause you.

10/05/11

Are you Ready?

ICD-10 Basics

HNS urges all providers to begin preparing now for the ICD-10 transition to make sure you are ready by the October 1, 2013, compliance deadline. The following quick checklist will assist you with preliminary planning steps.

Identify your current systems and work processes that use ICD-9 codes. This could include your clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts, etc. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place and because ICD-10 can only be used for dates of service on or after October 1, 2013, (and providers will still be filing for claims prior to October 1, 2013 after this date) your systems will need to be able to use both ICD-9 and ICD-10 codes simultaneously.

Talk with your practice management software vendor about accommodations for both Version 5010 and ICD-10 codes.  

The effective date for 5010 is January 1, 2012.  Contact your vendor and ask what updates they are planning to your practice management system for both Version 5010 and ICD-10, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement. If you are in the process of making a practice management or related system purchase, ask if it is Version 5010 and ICD-10 ready.

Discuss implementation plans with all your clearinghouses, billing services, and payers.   Contact organizations you conduct business with such as your payers, clearinghouse, or billing service. Ask about their plans for the Version 5010 and ICD-10 compliance and find out when they will be ready to test their systems for both transitions.

Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.

Assess staff training needs and start NOW to prepare everyone in your office. Identify the staff in your office who code, or have a need to know the new codes.

Budget for time and costs r elated to ICD-10 implementation, including expenses for system changes and training. Assess the costs of any necessary software updates, reprinting of superbills, training and related expenses.  Unfortunately, the conversion to ICD-10 may create delays in payments so be aware of this and budget accordingly.

TEST, TEST, TEST!  Be sure to test using Version 5010 / ICD-10 codes with your payers and clearinghouses well before the deadline

Testing is critical. Allow yourself enough time to first test that your Version 5010 transactions, and subsequently, claims containing ICD-10 codes are being successfully transmitted and received by your payers and billing service or clearinghouse. Check to see when they will begin testing, and the test days they have scheduled. If you submit electronic claims, you need to have completed internal testing of Version 5010 systems in time to begin external testing with your payers, clearinghouses, billing services, and other business partners by January 1, 2012.

09/22/11

Reminder.

Unlisted modality/procedure/service codes cannot be billed through HNS, including but not limited to CPT 97039.  If you need assistance in determining the appropriate code to bill please contact your HNS Provider Rep.

09/22/11

Reminder! Chiropractors cannot prescribe drugs.

§ 90-151. Extent and limitation of license.

Any person obtaining a license from the Board of Chiropractic Examiners shall have the right to practice the science known as chiropractic, in accordance with the method, thought, and practice of chiropractors, as taught in recognized chiropractic schools and colleges, but shall not prescribe for or administer to any person any medicine or drugs, nor practice osteopathy or surgery. (1917, c. 73, s. 12; C.S., s. 6722; 1933, c. 442, s. 3.)

HNS POLICY

Neither HCPCS code A9150 (non-prescription drugs) nor any code indicating drugs have been provided by a HNS provider can be reported on claims filed through HNS.

§ 90-151.1. Selling nutritional supplements to patients.

A chiropractic physician may sell nutritional supplements at a chiropractic office to a patient as part of the patient's plan of treatment but may not otherwise sell nutritional supplements at a chiropractic office. A chiropractic physician who sells nutritional supplements to a patient must keep a record of the sale that complies with G.S. 105-164.24, except that the record may not disclose the name of the patient. (1997-369, s. 1.)

09/21/11

CE Certificates

HNS has mailed CE Certificates to all providers who attended Dr. Sharp's Charlotte CE Seminar on July 30th.  Credit hours have been reported to the NC BOCE.

09/01/11

NC PROVIDERS:

BCBSNC SYSTEM ISSUE

BCBSNC has experienced a system glitch involving claims that were submitted on July 14th, 2011.   While some claims were processed correctly, many claims submitted on this date were not adjudicated. 

Please check your EOBs for claims submitted for adjudication and should you find any claims that have not processed, please fax your Provider Representative the following information regarding each patient:

• Patient’s Name
• Date of Birth
• Date of Service
• Insurance ID Number

 

Please be sure notify HNS of any claims submitted on July 14 that have not been adjudicated.

If you have any questions please contact your HNS Provider Representative and she will be happy to assist you.

CHANGE TO NC STATE COPAYS

Reminder to NC providers:  Effective today, the following changes to the N. C. State Health Plan for chiropractic services are in effect.

Standard Plan (80/20):

Co-payments - $52.00  per individual

Basic Plan (70/30): 

Co-payments $64.00 per individual

08/22/11

Important reminder regarding 5010.

The count down is on for conversion to 5010! 

Please remember that effective January 1, 2012, PO Boxes can no longer be submitted in the "billing provider" field of your claims.

5010 requires this field to be completed with a street address.  We want to make sure you do not experience unnecessary delays in the processing of your claims so please contact your software vendor to make sure this change is made prior to the deadline.

Please note that a PO box can be entered in the "pay to provider" field. 

08/19/11

A reminder to all providers-

HNS policy – Treatment of family members

  Providers should not provide chiropractic treatment to family members

  and HNS providers may NOT bill HNS contracted payors for chiropractic  

  services  provided to the following:

 Family members include:

Spouse

Eligible domestic partner

Children /step children

Siblings (including natural, step, half)

Parents/step parents

Parent’s-in-law

Brothers/sister-in-law

Nieces/nephews

Grandparents

Billing for electrodes with electrical stimulation

Please remember that HNS providers cannot bill electrodes when billing for electrical stim (97014, 97032) or TENS units.  If you inadvertently bill and receive payment for electrodes, these funds must be returned to the payor by promptly filing a corrected claim.  Please contact your HNS Rep if you have any questions or need assistance.

07/01/11 

EFT REGISTRATION!

Please remember that effective August 1, 2011, all monies received by HNS from our contracted payors will be sent to providers via EFT and all EOBs will be available only via the HNS secure website.  To comply with this new policy and to avoid unnecessary delays in receiving payments from HNS payors, please be sure to register for EFTs by July 15,2011.

Please contact your HNS Provider Rep if you have any questions.

06/30/11

HNS will be closed on Monday, July 4th and will reopen Tuesday, July 5th.

06/17/11

NC Providers ONLY

Changes to N.C. State EMPLOYEEs health plan

Despite the tremendous efforts HNS and the NCCA, co-payments for the state health plan are increasing.

The new bill increases the  in-network specialist co-payment to $81.00 per covered individual except for chiropractic services, mental health and substance abuse services, and physical therapy, occupational therapy, and speech therapy services

Effective September 1, 2011, the following changes to the N. C. State Health Plan for chiropractic services will take effect.

Standard Plan (80/20):

Co-payments - $52.00  per individual

Basic Plan (70/30):

Co-payments $64.00 per individual

 

 06/08/11

SC Providers Only

CIGNA HealthCare -Timely Filing Change

Effective August 1, 2011, CIGNA HealthCare will change their Timely Filing Policy from 180 days to 90 days!   To avoid unnecessary denials, HNS urges you to submit all claims as soon as possible and to file any secondary claims as soon as you receive the EOB from the primary payor.  HNS recommends filing your claims on a daily basis and if that is not always possible, always file your claims no later than 10 days from the date of service.  The sooner you submit claims, the quicker you receive payment!

06/08/11

SC Providers Only

Decrease in Medicaid Payments - A Public Notice from the SC Department of Health and Human Services (SCDHHS)

Effective July 8, 2011, payment to Medicaid providers has been reduced.

Please note that the South Carolina Department of Health and Human Services (SCDHHS), as required by Federal Regulations of Title 42 Part 447 Section 205, gives notice of the following proposed cost savings measures regarding its methods and standards of reimbursement for Medicaid services provided under the State Plan under Title XIX of the Social Security Act Medical Assistance Program. Effective for services provided on or after July 8, 2011, SCDHHS will reduce provider payments by the amount indicated below.

Medical Professionals:

Podiatrist, Audiologist, Speech, Physical and Occupational Therapist, Licensed Independent Professional/Behavioral Health providers, Psychologist, Chiropractor - 7% rate reduction

06/08/11

SC Providers Only

SC Medicaid Providers must complete and return the Disclosure of Ownership and Control Statement.

HNS has just received notification from the South Carolina Department of Health and Human Services (SCDHHS) that effective 4/1/2011, the SCDHHS has mandated that all providers who contract with Medicaid through Absolute Total Care and Select Health of South Carolina must promptly complete and return the Disclosure of Ownership and Control Statement.

This Disclosure of Ownership and Control Statement must be completed and returned to HNS by June 20th, 2011.

Please click here for the Disclosure of Ownership and Control Statement, and mail the completed form to HNS at the address below no later than June 20th, 2011.

Health Network Solutions, Inc.

ATTN: MEDICAID Credentialing

PO Box 2368

05/08/11 Electronic Funds Transfers (EFT)

EFTs are here!  Please register before July 15, 2011!

Effective August 1, 2011, all monies received by HNS from our contracted payors will be sent to you via EFT.  HNS will no longer issue “paper” checks, so to avoid unnecessary delays in receiving payments from HNS payors, please be sure to register before July 15,2011. Please contact your HNS Provider Rep if you have any questions.

05/03/11

NC Providers Only

IMPORTANT UPDATE: Incorrect EOBs for Federal Employees (FEP)

BCBSNC has just advised HNS that the Federal Employees Program (FEP) has experienced technical difficulties with their electronic remittance files.  As a result, recent EOBs received by BCBSNC and forwarded to HNS include incorrect dates of service for those members.  Please note this issue is exclusive to members of the Federal Employee Program.

Per BCBSNC, the dates of service on EOBs you received in the April 30th HNS provider check packet will not reflect the correct date of service for members of the FEP.

The FEP department in Washington states that they are working to resolve this and expect to have this problem corrected by May 20th, 2011.

If you have any questions or if you need a corrected EOB for secondary claim filing, please contact your HNS Provider Representative.

04/26/11

New Electronic Solutions are here!

Electronic solutions reduce costs and increase efficiencies and are already in use by hospitals and medical professionals across the country, and after 2 years of design and development, HNS is proud to provide state of the art electronic solutions to the chiropractic profession in North Carolina, South Carolina and Virginia!

Our new electronic solutions include the transfer of HNS payments directly to your bank account (EFT), as well as electronic EOBs and the HIPAA compliant 835 file for automated payment posting to your patients’ accounts.

Registration begins June 1, 2011, and the registration process is via the secure section of the HNS web site. Registration is simple and takes just minutes to complete.  As soon as you complete the registration process, HNS will begin electronically transferring your funds directly to your bank account and will provide you with electronic EOBs and the 835 file for automated payment posting. 

HNS has redundant systems to assure the security of your data and we utilize the highest form of ecommerce security available, including McAfee Secure. But we don’t stop there! As soon as you enter your checking and routing numbers and hit the 'SUBMIT' button, your data is encrypted, assuring that no one, not even HNS employees have access to your checking and routing numbers.

Effective August 1, 2011, HNS will no longer issue paper remittances or paper EOBs HNS administrative policies require that all participating providers register for these new electronic solutions by July 15th, 2011. 

Please contact your HNS Provider Rep if you have any questions about our new electronic solutions.

040811

SC Providers Only

HNS has received notification that due to deficits in the state budget for fiscal year 2011, the Medicaid fees for many services have been reduced. 

Effective Friday, April 8, 2011, fees for certain Medicaid chiropractic services have been reduced by 3%.   

The HNS fee schedules impacted by this reduction include Select Health and Absolute Total Healthcare.  HNS has posted the updated fee schedules on the secure portion of this web site

4/14/11

Announcing New One Day FREE HNS CE Seminars  -

Managing For Success

We are excited to announce that Dr. Kevin Sharp will be providing FREE seminars for HNS physicians and CAs in 3 locations.

Raleigh (May 7, 2011)

Charlotte (July 30, 2011)

Winston-Salem (September 24, 2011)

These FREE HNS seminars have been approved by the NC BOCE and meet the mandatory Board requirement for 6 hours of CE on Documentation, Coding and Compliance.  Dr. Sharp’s seminars are open to HNS providers and billing CAs.  Because space is limited to only 125 guests, only one CA may attend, and each CA must be accompanied by an HNS provider.  HNS will host a “Lunch & Learn” session from 12 noon – 1:30 at each seminar and FREE lunch will be provided for all registered guests. To learn more about these seminars and to register, please CLICK HERE to login into the secure HNS web site and click on Documentation Seminars in the navigation bar.

03/19/11

CIGNA UPDATE

Cigna Healthcare has recently sent out a letter regarding Great West and the Great West provider network.

Per CIGNA, this letter was sent in error to chiropractors in NC and SC, so please disregard this letter. CIGNA will advise HNS if there are any changes regarding Great West claims and we will promptly let you know as soon as we receive any more information.

02/28/11  - CIGNA ELIMINATES CCI EDIT!

HNS is pleased to report that CIGNA has removed the CCI edit that prevented the payment of both 97012 and 97140 when billed for the same patient on the same date of service.  CIGNA is working to reprocess those claims that were processed subject to this edit, so please do not submit corrected claims, and please be advised that it will take several months for CIGNA to reprocess all of these claims.

02/07/2011

SC Providers

Important announcement regarding ATC

HNS is pleased to announce that Absolute Total Care (ATC) has informed us they now include a limited number of radiology codes as covered chiropractic services.

Please review the following list of ATC covered radiology codes, and utilize these services as needed for your ATC patients.

72010 – Entire spine, AP & Lat - $53.29

72040 – Cervical AP & Lat - $28.31

72070 – Thoracic AP & Lat - $26.07

72080 – Thoracolumbar AP & Lat - $27.18

72100 – Lumbar AP & Lat - $29.71

Also, just a reminder that ATC no longer requires preauthorization for chiropractic services but you MUST verify eligibility for each  patient prior to treatment.

1/14/11

NC Providers CE Seminar Registration

Registration for the 2011 Free CE from HNS Seminar is now OPEN. The HNS CE seminar will be held at the Sheraton/Four Seasons in Greensboro, NC on March 5th & 6th. There are two great 12 hour programs for you to choose to attend. Please don’t forget to sign up for the free HNS cocktail party on Saturday night!  Registration can be done through the secure section of this website. Please CLICK HERE to register.

HNS is closed!  --

WEATHER UPDATE!

The HNS offices are closed today, January 10, 2011 due to the weather.  We hope to reopen tomorrow at 10am.  The January 10th checks will not be issued until tomorrow.  We apologize for the delay and will get the checks in the mail as soon as possible after we return to work.

12/20/10 Holiday Schedule

HNS will be closed Thursday and Friday, December 23 and 24th and will reopen on Monday, December 27th, 2010.

12/15/2010

SC Medicaid benefit changes for 2011

11/20/10

HNS offices will be closed on Thursday and Friday, November 25, 26 for the Thanksgiving holidays.  We will reopen at 7:30am, Monday, November 29th.

11/15/10

In August of this year, HNS announced that CIGNA Health Care had implemented the use of certain CCI edits that resulted in the bundling of 97140 and 97012 when billed on the same date of service on the same patient.  Further, we informed you that this was inconsistent with the HNS/CIGNA fee schedule and we were working with CIGNA to get this resolved. 

Since August of this year, HNS has been working with CIGNA network management to remove these edits.  While the edits have not been removed, we are hopeful that they will be removed by the end of this year.  In the interim, CIGNA has agreed to reprocess all HNS claims impacted by this edit.  These claims must be manually reprocessed by CIGNA, so it will be several weeks before all claims are reprocessed. 

Please do not file any corrected claims associated with this issue; CIGNA is identifying these claims from information submitted by HNS and will internally correct these claims   - so please do not file corrected claims.  If you have any questions regarding this issue, please contact your HNS Provider Rep.

11/09/10

Billing for electrodes with electrical stimulation

Please remember that it is inappropriate to bill for electrodes when billing for electrical stim (97014, 97032) or TENS units. The relative value of the applicable codes includes reimbursement for electrodes. 

If you inadvertently bill and receive payment for electrodes, these funds must be returned to the payor by promptly filing a corrected claim.  Please contact your HNS Rep if you have any questions or need assistance.

11/03/10

HNS has added a provider directory to our website and many contracted payors are including a link to the HNS website on their website's, to assist members with finding an "in-network" provider.  This directory will be updated each month to include provider changes and providers who have just joined the network.

10/19/10

One edit issue resolved!

We are pleased to report that CIGNA has corrected the edit that resulted in the inappropriate denial of initial examinations.  If you have any questions about this issue, please contact your HNS Provider Rep for assistance.

10/12/10

The newly revised HNS Practice Protection Plan is now back on the website. Please print this new version and please call us if you have any questions.

09/21/10

Update on CIGNA "bundling" edits

HNS is working with CIGNA network management in an effort to eliminate the use of the CCI edits that are resulting in the bundling of 97140 and 97012, when billed on the same date of service on the same patient.  HNS has provided CIGNA with information from CMS and the ACA indicating that this bundling is inappropriate use of the CCI edits with respect to these chiropractic services.  We are optimistic that we will be able to get CIGNA to agree to eliminate the use of these edits and to reprocess claims impacted by these edits. 

09/13/10

Many of you have contacted us regarding a problem with the inappropriate adjudication of initial E/M services billed to CIGNA health care.  CIGNA has completed a new edit to their claims processing system that has resulted in the incorrect denial of initial exams codes. HNS immediately contacted CIGNA and they are working to get this corrected as soon as possible. As soon as they advise us that this problem has been corrected, we will notify you so that corrected claims can be filed to get these services properly paid.  We regret the inconvenience this CIGNA system problem has created and we will continue to push for a speedy correction to this problem.   If you have any questions about this, please contact your HNS Provider Rep. 

09/07/10

To better assist you, HNS is revising and reorganizing the HNS Practice Protection Plan with additional information. We will have the new HNS Practice Protection Plan
on this website shortly.    In the interim, please refer to the HNS/HNS Payor Policy section located under the Provider tab on this website.  We appreciate your patience and please contact your HNS Provider Rep if you have any questions. 

09/07/10

Revised Business Associate Agreement

HNS has just mailed you, via certified mail, an addendum to the Business Associate Agreement which is part of your HNS Practitioner's Participation.  This addendum is required to comply with certain regulations included in the HITECH Act.  Network providers do not have to take any action with respect to this addendum unless you object to the addendum. If you do object to the required addendum, you must notify HNS in writing within 30 days of receipt of the addendum.  If you do not object, in writing, within 30 days, the addendum will be incorporated into your HNS Practitioner's Participation Agreement.

08/18/2010

NEW HNS FORMS

HNS has revised the format of our website.  All HNS Forms are now accessible on the home page under the new tab titled "HNS Forms".   These forms are in 'word' format and can be customized with your name or the name of your practice.  We hope you will take a moment to review all of the forms in this new section.

3RD QUARTER NEWSLETTER

The 3rd Quarter HNS E-Newsletter was sent to all providers yesterday (08/17/10) and includes information regarding our payor contracts and other information to help you protect your practice.

lf you have changed your email address and did not receive this newsletter, please contact your HNS Provider Rep.

08/02/2010

ALL CIGNA Providers –

IMPORTANT Notice regarding bundling of certain codes

CIGNA HealthCare has recently implemented Medicare’s Correct Coding Initiative (CCI) which prevents the payment for Manual Therapy (97140) when billed together with mechanical traction (97012) on the same date of service.  

CCI is a system of coding edits that Medicare and some commercial payors use to determine if codes should be paid separately or bundled together. The new CIGNA CCI edit considers 97140 and 97012 to be a comprehensive code set and will bundle these codes even when a Modifier -59 is used.

Additionally, certain CIGNA plans are utilizing these same CCI edits with respect to E/M services provided on the same date of service as CMT services, so when verifying benefits, please be sure to obtain clarification about this prior to providing care to your CIGNA patients.

HNS will continue to work to eliminate the use of any edits that negatively impact reimbursement for our network providers.

July 26th, 2010.

SC HNS Providers:

The SCCA Annual Convention is Thursday, July 28- August 1, 2010.  HNS is proud to be a platinum sponsor for this great convention and to provide free continuing education at this convention for our HNS SC providers.  We look forward to seeing our SC providers at the 2010 SCCA Annual Convention.

06/22/2010

Attention ALL CIGNA providers:

NEW DME Vendor Procedure –

In an effort to provide better service to their members, CIGNA HealthCare has expanded their DME vendors to include multiple vendors. Apria was previously the only CIGNA DME vendor but is now just one of many CIGNA DME vendors.  In order to find the best DME vendor for your CIGNA members, please contact CareCentrix at 888-999-2422 and they will assist you with finding the most convenient DME vendor for your CIGNA patients. The process is easy and no referral form will be needed. Additional information can be found on the CIGNA HealthCare Guide under the “All About Claims” tab on this website or please contact your HNS Provider Representative if you have questions.

05/22/10

Attention N. C. Providers

Federal Employees Health Plan

Please remember that BCBSNS is the plan administrator for the Federal Employees Health Plan and chiropractic benefits are not subject to the BCBSNC Corporate Medical Policy.  Please contact the FEP directly to verify chiropractic benefits.

05/17/10 SC Providers

Free CE from HNS

Don't forget to register for the SCCA Annual Convention in Myrtle Beach and let HNS pick up the tab for half the costs of your required CE credits! 

03/26/10

The HNS Provider Utilization reports for calendar year 2009 were mailed on March 25, 2010.   If you qualified for the 'Excellence in Action" dividend check for 2009, your check is included in this UM packet. 

The objective of our UM program is to make you aware of how your practice patterns compare to those of your peers in the HNS network and to allow you to be aware of potential problem areas BEFORE your utilization patterns come to the attention of the payors.

It is very important that you carefully review the information contained in your UM packet.  If your report indicates that your UM status is "PROBATION", you are at risk for termination from the network, so we urge you to immediately work to bring your utilization patterns in line with your peers.

If you have any questions about your report, please contact your HNS Provider Representative.

03/23/10 NC PROVIDERS - GREAT NEWS ABOUT maintenance care. 

Piedmont Gas Company, (a self funded employer whose health plan is administered by BCBSNC) has agreed to cover maintenance/supportive care as part of their chiropractic benefits!  THIS IS EFFECTIVE TODAY. This is the second self funded employer group to agree to cover maintenance and supportive care as part of their chiropractic benefit package.  The City of Cary also now covers maintenance and supportive care. So please remember that you may now provide maintenance and supportive care as a covered benefit to members under these two health plans.

03/23/10 BCBSNC COPAY PROBLEM

HNS wants to make you aware that there appears to be a BCBSNC "system glitch" .  This glitch is preventing copayment's from being applied to payments for certain claims.  BCBS is working to correct this problem as quickly as possible.  If you receive EOB's that indicate that no copayment was applied, please immediately contact your HNS Provider Rep.

01/31/10 NEW FORMS ON WEBSITE

The new HNS forms are now available on the secure portion of this website.  We have added a new section titled "HNS forms" and all forms are included in this section.

These forms are formatted such that you can save them to your computer, customize with your name or practice name and then be ready to use.  If you have any questions, please contact your HNS Provider Rep and she will be happy to assist you.

01/20/10

On January 14th, HNS notified you that BCBSNC had identified an internal system glitch which resulted in network providers receiving BCBSNC payments at less than the HNS contracted fees as well as payments in excess of the HNS fee schedule.   This occurred for dates of service on or after January 1, 2010.  As a result, HNS suspended transmission of all BCBSNC claims until this problem was resolved but at this time all claims have now been released to BCBSNC.

BCBSNC regrets that this problem occurred and is working diligently to resolve all outstanding payment issues associated with this problem.  

Per BCBSNC, network providers should NOT submit corrected claims for any dates of services affected by this problem.  BCBSNC is handling the correction of these claims internally and HNS will notify you as soon as possible regarding when you can expect payment and/or recoupments associated with this issue.

 1/15/10

nc providers

rEGISTER online NOW

for our free 2010 ce seminar!

April 16, 17, & 18, 2010

Our online CE seminar registration is located on the secure portion of this website and includes additional information about our 2010 seminar.  Please remember that you will need your NC license number and your HNS user name and password to register.)

Our Free CE Seminar for 2010 is scheduled for April 16, 17, and 18 and includes a

special Post Payment Audit Provider Workshop on Friday, April 16th - for all providers and staff members! 

NC BOE approved CE programs (physicians only):

Dr. Art Croft will be presenting the final 12 hours (module 4) required for certification in Brain Injury Traumatology. 

As an alternative to Dr. Croft, and to assist you with meeting the new NC BOE CE requirements, we are also offering ring 6 hours on Ethics and Professional Boundaries as well as 6 hours on Documentation, Coding and Compliance.  

We look forward to seeing you in at the seminar and the HNS Cocktail Reception on Saturday night, April 17th.

01/14/10

NC Providers

IMPORTANT BCBSNC NOTICE!

BCBSNC has identified an internal system glitch that is resulting in our network providers receiving BCBSNC payments at less than the HNS contracted fees.  This is occurring for dates of service on or after January 1, 2010. 

BCBSNC is working diligently to correct this problem and expects to have this resolved quickly.  To prevent our providers from having to file corrected claims, HNS will not be transmitting any claims to BCBSNC  - until they have advised us that this problem has been corrected.

01/11/10

NC Providers

IMPORTANT BCBSNC REMINDER

NC Health Choice Claims

 Please remember that NC Health Choice claims should not be sent to HNS.  These claims must be sent directly to BCBSNC for proper adjudication.

BCBSNC ID numbers for these members begin with alpha prefix:                               

                                   YPCW

Many of you have reported that these claims have not been properly adjudicated by BCBSNC.  After reviewing these claims, we have learned that these claims were inadvertently sent to HNS.  So please remember to send all claims with alpha prefix YPCW directly to BCBSNC.

01/05/10

NC Providers

April 16, 17, & 18, 2010 - HNS Free CE Seminar

Our Free CE Seminar for 2010 is scheduled for April 16, 17, and 18, so please mark your calendars now and SAVE THE DATE!  

Special Post Payment Audit Provider Workshop on Friday, April 16th - for all providers and staff members! 

NC BOE approved CE programs:

Dr. Art Croft will be presenting the final 12 hours (module 4) required for certification in Brain Injury Traumatology. 

As an alternative to Dr. Croft, we will also be offering 6 hours on Ethics and Professional Boundaries as well as 6 hours on Documentation, Coding and Compliance.   Successful completion of these two 6-hour programs will allow you to meet the new NC BOE CE requirements.

Registration information will be sent to you shortly!  We look forward to seeing you in 2010 at the seminar and the HNS Cocktail Reception on Saturday night, April 17th.

ALL Providers

REMINDER - KANAWHA CLAIMS

Just a reminder that all Kanawha claims must be filed to HNS by 12/31/09.  Kanawha no longer has employer groups accessing the KHS network and they will not have a "claims run out" period, so please remember to submit all Kanawha claims to HNS prior to December 31, 2009.

NC Providers

12/23/09

Update on Medicare Advantage and Part D Compliance Training

BCBSNC has notified HNS that at present, they are not requiring providers to provide evidence that the Fraud and Abuse Training has been completed.  They are still working on this project and will let us know as soon as there are any updates.

NC Providers

11/24/09  Important BCBSNC notice

Due to a system glitch, BCBSNC has issued multiple payments for the same date of service. Per BCBSNC, they will begin recouping these overpayments from future EOB's shortly.

Please remember that the message posted by BCBSNC on Blue e asking that providers refund these monies does not apply to HNS network providers.  Please do not refund any of these overpayments.

If you have any questions about these recoupments, please contact your HNS Provider Representative and she will be happy to assist you.

ALL Providers

11/23/09 IMPORTANT CIGNA ANNOUNCEMENT

Please be aware that 97124 is a non-covered service under almost every CIGNA Health Care chiropractic benefit plan.  99% of all 97124's billed through HNS have been denied as non-covered under the member's plan.  We are receiving many calls from physicians who provided this service only to have payment denied by CIGNA because it was not a covered benefit under the member's plan.  We strongly recommend that you treat this as a non-covered service for CIGNA members and obtain a signed waiver from the member prior to treatment, and retain this in the health care record.

ALL Providers

IMPORTANT CIGNA UPDATES

1. Because of CIGNA' s internal CCI bundling edits, you should append CPT 97112 with the modifier 59, or the service may be bundled with the CMT code. So please be sure to add 59 whenever you bill 97112 together with a CMT code.  

2. While most CIGNA claims (for dates of service on or after 10/01/09) are properly adjudicating, per the new fee for service fee schedule, CIGNA has experienced a technical glitch with one of their many operating systems.  This has resulted in the payment of the global fee, rather than the fee for service fee schedule, for claims processed on this particular system. They are working to correct this and we will advise you just as soon as they notify that this has been corrected.

NC Providers

Save The Date!

April 16, 17, & 18, 2010 - HNS Free CE Seminar

Our Free CE Seminar for 2010 is scheduled for April 16, 17, and 18, so please mark your calendars now and SAVE THE DATE!  

Dr. Art Croft will be presenting the final 12 hours (module 4) required for certification in Brain Injury Traumatology. 

As an alternative to Dr. Croft and to assist you in meeting the new NC BOE CE requirements, we will also be offering 6 hours on Ethics and Professional Boundaries as well as 6 hours on Documentation, Coding and Compliance.

We look forward to seeing you in 2010 at the seminar and the HNS Cocktail Reception on Saturday night, April 17th.

11/02/09

SC Providers

SC Provider Announcement

HNS has just been notified that on July 1, 2009, SCDHHS has included chiropractic as a medicaid benefit as part of the MCO (Managed care organization) benefit package.

This MCO program is called First Choice and is administered by Select Health of SC and Select Health of SC has contracted with HNS for chiropractic services. 

Effective 10/01/09, First Choice Medicaid chiropractic benefits are limited to 8 visits per recipient, per year.  Chiropractic services are available to all First Choice recipients, however, HNS providers must call to verify benefits and call for the pre-authorization code needed for box 23. Chiropractic services are limited to manual manipulations only.

ALL Providers

10/28/09

CIGNA Reminders:

The inclusion of a service on any fee schedule is not necessarily an indication that it is a covered service under a particular plan, so please remember that you must continue to verify benefits for all patients prior to treatment.

The effective date of the new fee schedule was October 1, 2009.  Claims for dates of service prior to 10/01/09 will continue to be adjudicated at the global rate of $45.00.  Claims for dates of service on or after 10/01/09 will be adjudicated per the new fee-for-service fee schedule. 

Any claim for dates of service prior to October 1, 2009 received after October 20, 2009 will be processed with the 7.5% HNS admin fee.  

CIGNA HealthCare will not reimburse providers for ANY services other than those listed on the new CIGNA fee schedule.  Services other than those listed on the fee schedule will be denied by CIGNA HealthCare.  

ALL Providers

10/10/09

Just a reminder that the new edit was added to HNSConnect (previously ChiroTrack) on Friday, so any duplicate claims that you submit will no longer be transmitted to the payors and will now error back to you.  If you have any questions about this new edit, please contact your HNS Provider Rep.

ALL Providers

09/30/09 # 1

IMPORTANT CIGNA ANNOUNCEMENTS: CIGNA HealthCare will not reimburse you for any services other than those listed on the new CIGNA fee schedule.  Services other than those listed on the fee schedule will be denied by CIGNA HealthCare.  To be sure that you are familiar with the CPT codes listed on this new CIGNA fee schedule, please print a copy and keep it in a convenient location for quick reference.  All HNS fee schedules are located on the secure portion of the HNS website: www.HealthNetworkSolutions.net.  The inclusion of a service on the fee schedule is not necessarily an indication that it is a covered service under a particular CIGNA plan, so please remember that you must continue to verify benefits for all patients prior to treatment.

The effective date of the new fee schedule is October 1, 2009.  Claims for dates of service prior to 10/01/09 will continue to be adjudicated at the global rate of $45.00.  Claims for dates of service on or after 10/01/09 will be adjudicated per the new fee-for-service fee schedule.  Claims run-out period.  All primary claims for dates of service prior to October 1, 2009 must be submitted through HNS no later than October 20, 2009.  Primary claims for dates of service prior to October 1 submitted after October 20 will not be processed so please make sure to send all such claims prior to October 20, 2009.

All primary claims must be submitted for adjudication within 6 months from the date of service or the claim will be denied. (For coordination of benefits - claims will be considered based on the primary carrier’s processing date stated on the EOB.)

ALL Providers

09/30/09 UPDATE # 2

New "Duplicate Claim" Edit added to HNSConnect  

To reduce your denials and save you valuable time, we have added a new feature to HNSConnect, our electronic claims filing system.  Effective October 12, 2009, HNSConnect (formerly ChiroTrack) will notify you when a previously submitted claim is received. These claims will error back with a message indicating that the claim is a duplicate and should not be resubmitted.  The claims filing process is a challenge; and inadvertently submitting claims that were previously submitted to the payors for adjudication, takes time to undo.

The Duplicate Claim Edit feature is designed to enhance your office productivity by alerting you that a claim has been previously submitted to the payor for adjudication.  Remember, if a claim rejects as a “duplicate” on HNSConnect, it has been previously submitted electronically.  If you have not received payment for the claim, the first step is to research the status of the claim.  Please contact your Provider Rep if you need assistance.

ALL Providers

09/27/09 Update

4 HOURS OF FREE CE - NOW AVAILABLE ON THIS WEBSITE!

The CE course “Documentation, Coding and Compliance for Proper Reimbursement,” presented by Dr. Mario Fucinari, is now available FREE on the secure section of our website at www.healthnetworksolutions.net.   Dr. Mario Fucinari, a well-known NCMIC speaker and consultant for chiropractic documentation and billing procedures provides an excellent program on documentation, coding, and compliance.  The four hour continuing education web seminar is approved for CE credits by both the NC BOE and the SC BOE. After passing the 10 question quiz, an email will be sent to you (and HNS) confirming your four CE credit hours.  On your behalf, HNS will report those earned credit hours to your state Chiropractic Board of Examiners.

 NC Providers

09/21/09 Update

GOOD NEWS for NC Providers

Important Announcement Regarding City of Cary Employees

HNS has just been contacted by BCBSNC regarding employees of the City of Cary, NC. 

Maintenance and supportive care ARE covered chiropractic benefits for City of Cary employees.

At the present time, there are no other BCBSNC self-funded (ASO) groups whose chiropractic coverage includes maintenance and supportive care.

NC Providers

09/10/09

PI Case- Update for all NC Providers:

Just a reminder that HNS providers must file claims through HNS for all covered services provided, including services provided to PI patients and HNS providers cannot collect more than the HNS allowable amount for any covered service provided.    Please remember that if you should need to do so to assist with settlements, you may submit your charges to the attorney or third party liability carrier but under no circumstances can you collect more than the allowable amount for those services, from any attorney or 3rd party payor.  Any excess monies (over the applicable copayment, coinsurance and/or deductible) must be promptly refunded to the patient.)

ALL Providers

07/25/09

Identity Theft – Red Flag Rules

Deadline Delayed-

To assist providers and other entities, the Federal Trade Commission staff will redouble its efforts to educate them about compliance with the "Red Flags" Rule and ease compliance by providing additional resources and guidance to clarify whether businesses are covered by the Rule and what they must do to comply. To give providers, creditors and financial institutions more time to review this guidance and develop and implement written Identity Theft Prevention Programs, the FTC will further delay enforcement of the Rule until November 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 HNS 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.

ALL Providers

7/16/09

Important Correction for CIGNA

MISSION claims -

CIGNA HealthCare has just informed HNS 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 HNS.  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.  As always, if you have any questions, please contact your HNS Provider Rep for assistance.

NC Providers

06/29/09

Important BCBSNC Announcement for NC Providers

Effective immediately, HNS 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 HNS.

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

ALL PROVIDERS - IMPORTANT NOTICE

05/29/09

HNS has recently mailed your annual utilization reports and to those who qualified, your Excellence in Action bonus check is included in your packet.  Please remember to contact your HNS Provider Rep is you have any questions or if we can provide any assistance to you.

Also, for those providers whose utilization patterns are outside the HNS range of acceptance, you will be contacted by a HNS Representative within the next 30 days to offer assistance and if to arrange for you to talk to a member of the CQI Committee, if you so choose. 

The CQI Committee recognizes that certain providers may have substantive reasons to support higher than normal utilization patterns.  For example, HNS providers who are Diplomates of the American Chiropractic Neurology Board, who frequently perform nerve conduction studies, which are relatively costly procedures, and could explain a higher than normal “cost per visit” and higher than normal “total allowables per visit” than other network providers.  

If the provider believes that the utilization review is not accurate or is not appropriate with respect to his particular practice, he should notify the CQI Committee, in writing, within 30 days of receipt of his individual utilization report.

Additionally, the provider must provide the Committee with substantive supporting documentation with respect to his utilization, including the reasons he believes that his utilization patterns can be justified.  Upon receipt of the supporting documentation, it is the policy of the CQI Committee to change the provider’s utilization status indicated on the HNS utilization report to “pending”, pending a review and analysis of the information provided to CQI Committee.   Once the review and analysis of the information is completed, the CQI Committee will notify the provider of the committee’s decision, with respect to his utilization status with HNS.  The Committee will respond to the provider, in writing, within 120 days of receipt of the documentation.