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July 26th, 2019
Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage
Published July 26th, 2019 - Last Review/Update August 8th, 2019|
Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky. In their notice, Anthem states: "Effective for all commercial ...
September 25th, 2015
Coordination of Benefits
Published September 25th, 2015|
Coordination of benefits, (COB) is a clause in most group policies, which is in place to minimize the over-payment or duplicate payment of claims. COB applies to patients covered by more than one insurance plan and limits the amount paid by each plan. With the COB clause the payments made by ...
February 25th, 2015
Aetna Policy on Bathroom and Toilet Equipment and Supplies - Coverage
Published February 25th, 2015 - Last Review/Update February 18th, 2016|
Clinical Policy Bulletin:Bathroom and Toilet Equipment and Supplies Number: 0429 Policy Aetna's HMO-based and health network plans (HMO, QPOS, Health Network Only, Health Network Option, Golden Medicare, and U.S. Access) generally follow Medicare's criteria for durable medical equipment (DME) items that are used in the bathroom. Most DME items used in the bathroom are ...
February 13th, 2015
Chiropractic Services - Aetna Clinical Policy Bulletin
Published February 13th, 2015 - Last Review/Update March 1st, 2016|
AETNA Clinical Policy Bulletin: Chiropractic Services Number: 0107 http://www.aetna.com/cpb/medical/data/100_199/0107.html Policy Note: Some plans have limitations or exclusions applicable to chiropractic care. Please check benefit plan descriptions for details. Aetna considers chiropractic services medically necessary when all of the following criteria are met: The member has a neuromusculoskeletal disorder; and The medical necessity for treatment is clearly documented; and Improvement is ...
December 19th, 2014
Medicare Parts C & D Fraud, Waste, and Abuse Training and General Compliance Training
Published December 19th, 2014 - Last Review/Update March 1st, 2016|
All persons who provide health or administrative services to Medicare enrollees must satisfy general compliance and FWA training requirements. This module may be used to satisfy both requirements. This training module consists of two parts: (1) Medicare Parts C & D Fraud, Waste, and Abuse (FWA) Training and Compliance Objectives: Meet the regulatory requirement ...
July 31st, 2014
CMS has announced a new Provider Relations Coordinator
Published July 31st, 2014 - Last Review/Update January 25th, 2017|
07/08/2014 CMS has announced a new Provider Relations Coordinator, Latesha Walker. Latesha is your point of contact for RAC audits. Medicare will do no additional RAC reviews under the current contract; they are making changes to improve the current program. The final date Auditors sent claim adjustment files to Medicare ...
July 8th, 2013
Denials for 97140 (Manual Therapy)? Here's the story.
Published July 8th, 2013 - Last Review/Update January 27th, 2017|
The ChiroCode Institute has received several inquiries over the last few months regarding a denial for 97140 (Manual therapy—such as myofascial release or trigger point therapy) when billed with 98940-98942 (Chiropractic Manipulative Treatment - CMT) on the same visit. Most payers follow Medicare’s guidelines for the use of this code, ...
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