Signing Over BCBS checks

If you are an out of network provider, you know the importance of properly communicating to your clients to sign over received insurance checks. I suggest you do this on 3 occasions.

  1. When you realize the patient has BCBS have the initial conversation to prepare them, even create and sign a separate contract
  2. The last visit before they deliver
  3. At their PP visits

Please feel free to use the link below for verbiage options

https://favoredmedicalbilling.com/checks.php

 

Triwest Patient Reimbursement Form

Help your Triwest clients get coverage.. provide a claim form and have then submit the Triwest reimbursement form.

Site:  https://tricare.mil/FormsClaims/Forms/ClaimForms/Medical

Form: http://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/dd2642.pdf

Claims Address: https://tricare.mil/FormsClaims/Forms/ClaimForms/Medical/Addresses

 

 

TRICARE Policy Manual 6010.57-M Chapter 11 Section 3.12

TRICARE Policy Manual 6010.57-M Chapter 11 Section 3.12

Certified Nurse Midwife (CNM)  Authority: 32 CFR 199.6(c)(3)(iii)(D)

1.0 ISSUE   Certified Nurse Midwife (CNM).

2.0 POLICY
2.1 A CNM may provide covered care independent of physician referral and supervision,
provided the nurse midwife is:
2.1.1 Licensed, when required, by the local licensing agency for the jurisdiction in which the
care is provided; and
2.1.2 Certified by the American Midwifery Certification Board (AMCB). To receive certification, a
candidate must be a Registered Nurse (RN) who has completed successfully an educational
program approved by the AMCB, and passed the AMCB National Certification Examination.
2.2 The services of a RN who is not a CNM may be authorized only when the patient has been
referred for care by a licensed physician and a licensed physician provides continuing supervision
of the course of care.
3.0 EXCLUSION
A lay midwife who is neither a CNM nor a RN is not an authorized provider, regardless of
whether the services rendered may otherwise be covered.

Triwest/Tricare Health Net Federal Services NO LONGER covering claims for LM, CPM…

It has certainly been tough switching all my providers from Triwest UHC to HN. I found out today while checking on claims (that I was required to wait until 5/1/18 to follow up on), that Triwest HN will not credential nor process claims for Midwives that are not CNMs. Please see the manual I was directed to.

http://manuals.tricare.osd.mil/DisplayManualPdfFile/TO08/174/AsOf/tp08/c11s3_12.pdf

 

 

Attend Cigna FREE EFT Webinar – Get your money and claims processed faster!

Electronic Funds Transfer (EFT) is now Cigna’s required standard payment method. When you enroll in EFT, your payments will be deposited directly into your bank account, eliminating the need to wait for checks in the mail or make trips to the bank. The estimated administrative cost to receive a paper check payment is $2.89, compared to only $0.69 for the same electronic payment – a savings of 76 percent.*

Join us for an interactive, web-based demonstration about how to enroll in EFT on the Cigna for Health Care Professionals website (CignaforHCP.com). In addition, you’ll learn how easy it is to locate your online remittance reports for these payments. Register for a webinar today, and find out how EFT can benefit you and your patients with Cigna coverage.

Select a webinar date and register using the directions below.

Date Time (ET) Meeting number
Wednesday, May 30, 2018 1:30 PM 711 902 669
Thursday, May 31, 2018 10:00 AM 714 414 703
Friday, June 1, 2018 12:00 PM 713 091 368
Monday, June 4, 2018 11:00 AM 718 517 141
Tuesday, June 5, 2018 4:00 PM 718 154 322
Wednesday, June 6, 2018 12:00 PM 713 922 055
Thursday, June 7, 2018 3:00 PM 713 219 473
Friday, June 8, 2018 2:00 PM 715 045 725

 

Preregistration is required for each webinar:

To register for a webinar:

1. Click the link on the date of the webinar you’d like to attend from the options above.
2. Click the Register button
3. Enter the requested information and click Register.
4. You’ll receive a confirmation email with meeting details.
   
  * Council on Affordable Quality Healthcare® (CAQH)
Three ways to join the audio portion of the webinar:

Option 1 – When you link to the webinar, “Call me” will appear in a window. If you have a direct outside phone line, you can click this option. You’ll receive a phone call linking you to the audio portion.

Option 2 – Call 1.866.205.5379. When prompted, enter the corresponding Meeting number shown above. When asked to enter an attendee ID, press #.

Option 3 – Call in using your computer.

Questions?

Contact Cigna_Provider_eService@Cigna.com

the responsibility of the legality of that billing is 100% still yours, the Provider

Below are a few audio webinars on Out of Network Billing, Patient Collections, Billed Charges, Telemedicine and some recently shared pointers. Audio credit to Audio Educator shared pointers credit to Larsen Billing Company

  1. The Balance Billing Requirement – Why Out-of-Network Providers Must Balance Bill Their Patients

https://audioeducator-mp3.s3.amazonaws.com/2015/May/05-05-2015-Force-TLCTCI515B.zip

  1. Telemedicine 2017: Coding, Billing and Compliance Update

https://audioeducator-mp3.s3.amazonaws.com/2017/March/3zotSC2wb967662d81cGiA0zYWQ2ubf6e0f3fd4.zip

  1. Reconciling Cigna v. Humble with Aetna v. Humble and Their Impact on the Out-of-Network Provider

https://audioeducator-mp3.s3.amazonaws.com/2017/March/M6Nwt2EHQNf9ad70233eYE06AwhPIm92895d8521.zip

4. Larsen Billing – You, the provider, are responsible for coding. Billing services give advice and make suggestions on coding all the time, but if you cannot find evidence in the code books for the advice as it pertains to your services, you should not allow them to bill on your behalf. So even if your billing service picks your codes, you have ultimate responsibility for all of them.

  • States vary, but there is no overall statute of limitations on take backs, audits, or insurance fraud. That means that even if a code pays for ten years, it could be audited or investigated by the insurance company or local authorities, and you will be held liable to pay back, usually with interest, all funds that were improperly coded. A good billing service stands by their billing and coding and will help you gather the needed information in the case of an audit.

United Health Care insufficient record bogus Denial

United Health Care has started a recent trend… just wait, it is not a good trend. UHC has denied claims stating insufficient medical records even though records has NOT been officially requested. Please update your billers so these services are NOT prematurely written off.

Submit the claims, records, and denial of insufficient records for reprocessing.

Thank you