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 what's new?
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.
July 1, 2010
HNS offices will be closed on Monday, July 5 and will reopen on Tuesday, July 6th.
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 copayments 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
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