Health -
Managed Care
Blue Cross Blue Shield of
Texas
New fees for September 1, 2011 .......
reductions reported......
BCBSs Policy for Non-covered Physical
Therapy
Caution: Non-covered physical therapy
procedures are frequently billed using traditional physical therapy
modality codes that are covered. Example: Intersegmental traction
is inappropriately billed as code 97012, traction, mechanical.
You can have your patient sign an
agreement that they know the intersegmental traction is a
non-covered service and they will be financially responsible.
BCBS
Policies
 | No treating family members
and billing BCBS (same as Medicare)
|
| Billing when patient reaches
their Benefit Maximum |
Patient must agree in
writing to continue treatment and be financially responsible ......
and (Provider must charge allowed amount)
| Blue Cross reminds Contracted
Providers........ you must bill BCBS |
cash arrangements when
you're in-network in lieu of filing claims violates the provider's
contract
United HealthCare
| Charging United Healthcare
patients for non-covered services |
as long as you get the
patient's written consent before you do the non-covered service
| Arrange Substitute Coverage |
United says they
need to be in their network ...... or you will be paid
"out-of-network" benefits
| As of 2008 United (ACN) has
decided Spinal Decompression is "unproven"
|
| As of 1-1-07 97014 will be
reported with the G0283 code. |
| As of 1-1-07 hot/cold (97010)
will not be reimbursable. |
| 99070 will not be a processed
code, use HCPCS codes |
AETNA -
Reduction for multiple procedures
 The
following policy change was communicated in the
June 2011 issue of
Aetna OfficeLink Updates.
Once effective,
this policy will apply to non-facility claims only:
Effective for dates of service on or after 11/14/2011, multiple
procedure reductions will be applied to certain therapy procedures.
The procedure with the highest practice expense RVU will be allowed
at 100 percent. The practice expense portion of each additional
therapy service performed by the same provider group on the same
date of service will be allowed at 80 percent.The
Therapies – Modalities per Date of
Service payment policy still applies.
AETNA
AND ASH
- NOT IN TEXAS......YET...........
Effective July 1, 2011, ASH Networks is administering certain
components of the chiropractic benefits for all Aetna products
(including Medicare Advantage), except Traditional Choice®,
in Ohio and the Chicago market. To continue providing
chiropractic services to our members at their highest benefits level
in these markets, you need to contract with ASH Networks. If you
have not already received a credentialing package, contact ASH
Networks at
1-888-511-2743.
Did you know that .....
Aetna considers Spinal Adjusting Devices (Pro-Adjuster,
PulStarFRAS, and Activator experimental and
investigational......
| Aetna is asking for monies
back...... as far back as 2005...... Post Payment Audit
Appeal and contact Larry Laurent (attorney) 512-996-8844
|
| As of 1-1-07 hot/cold (97010)
will not be reimbursable.
|
| Aetna considers intersegmental
traction tables non-covered. (10-28-08)
click here to read policy on
intersegmental traction |
CIGNA
|
