| DEADLINE
FOR ELECTRONIC CLAIMS SUBMISSION
JANUARY
1, 2007
In an effort
to comply with requests from PCC payer networks, all claims submitted
through PCC need to be filed electronically beginning January
1, 2007 . PCC has formed an exclusive arrangement with Infinedi
to provide this service to our network at a discounted rate. If
you have not attended an Infinedi seminar, or signed up for electronic
claims submission through Infinedi, please contact the PCC office
to find out more information.
The only exceptions
for filing paper claims are:
- ManageMED
– They cannot accept electronic claims
- Secondary
Claims – These will need to come to our office along with
the primary EOB.
| CHANGES
TO PAYER ID LIST
PF06
American Healthcare Alliance
American Underwriters Life Insurance
9229
Ward Parkway, Ste 300
Kansas City , MO 64114
PF11
Fiserv Health
Zip should be 81002-0520
PF16
Fiserv Health
McCall Pattern Company
P.O. Box 520
Pueblo , CO 81002-0520
PF35
ManageMed
This
payer will drop to paper claims. You can either pay Infinedi
$0.50 a claim, or send the claim to PCC to be forwarded
at no charge to you.
PF48
Cigna
P.O. Box Should be 182223
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CONTRACT
AMENDMENT
An
amendment to the Kansas Participating Provider Agreement
was mailed to all contracting providers in September. The
amendment took effect October 1, 2006 . This amendment addressed
Section VI, Bills and Payment and Section VIII, Fees of
the agreement. These changes were implemented by the PCC
Board of Directors and are a result of changes PCC has made
to the way data is collected from the claims submitted by
our contracting providers. With our move to electronic claims
submission, these changes were necessary to enable PCC to
continue to provide accurate and timely data to our contracting
payers. If you did not receive a copy of this amendment,
or have questions regarding the changes, please contact
PCC at your convenience. |
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PRIME
HEALTH SERVICES |
Many
of you have received correspondence from Prime Health Services,
Inc. asking you to join their provider network. There is
no need for you to respond to this request since Preferred
Chiropractic Care, PA entered into an agreement with Prime
Health Services in June, 2006 which makes all contracting
providers in PCC a part of the Prime Health Services network.
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FREQUENTLY
ASKED QUESTIONS ABOUT INFINEDI
Q.
What
does fixed rate per month mean?
A.
This is set in place to keep providers from sending a
years worth of claims in one month. Please file claims
in a timely manner.
Q.
Can I only send PCC
claims through
Infinedi?
A.
No. All claims, commercial or private
may be filed with Infinedi.
Q.
What is the $0.50
per claim about?
A. If at anytime there would be a
payer group that cannot accept electronic claims then those
claims would be processed by Infinedi for $0.50 a claim.
Your office has the right to process these claims or to
let Infinedi process the claim.
Q.
Will my practice management software interface with Infinedi?
A. In most cases yes. All software questions should
be directed to Infinedi.
Q.
How soon can I start sending my claims to Infinedi?
A. After you have signed up as a PCC provider with
Infinedi, you will receive an email with forms attached
that
need to be printed and signed by the
doctor for each electronic payer you
will be using. This paperwork must
be returned to Infinedi before electronic
claims can be submitted on your
behalf. Please be sure to check your
email after you have completed the
initial enrollment with Infinedi. |
1500
CLAIM FORM DATES |
Oct.
1, 2006
Health plans, clearinghouses, and other information support
venders should be ready to handle and accept the revised
(8/05) Claims Form.
Oct.
1, 2006 – Mar. 31, 2007
Providers can use either the current (OLD) version or the
revised (8/05) version of the 1500 Claim Form.
April
1, 2007
The current (OLD) version of the 1500 Claim Form is discontinued;
only the revised (8/05) form is to be used. All rebilling
of claims should use the revised (8/05) form from this date
forward, even though earlier submissions may have been on
the current (OLD) 1500 Claim Form.
Jan.
3, 2006 – Jan. 1, 2007
Physicians and suppliers may not report an NPI on a CMS-1500
(OLD) form. Those forms do not contain fields for reporting
of NPI numbers. Providers must continue to enter their existing
Medicare identification numbers on those (OLD) paper form.
Prior to April 1, 2007 , Medicare will reject as unprocessable
any claim submitted on a CMS-1500 (OLD) form with an NPI
in a provider identification number field.
Jan.
2, 2007- Mar. 31, 2007
Medicare will accept either the CMS-1500 (OLD) or the revised
CMS-1500 (8/05) form. CMS-1500 (OLD) forms will continue
to be rejected as unprocessable if submitted with one or
more NPI’s . NPI’s can be submitted when a revised
CMS-1500 (8/05) is submitted, but NPI’s are not yet
required on these claims. If one NPI or more is reported
on a revised CMS-1500 (8/05), the submitter is strongly
encouraged to also submit the Medicare legacy provider identifier
that corresponds to each NPI reported on the claim. Failure
to report a legacy identifier with an NPI could result in
a delay in processing of the claims.
April
1, 2007 – May 22, 2007
Medicare will reject any CMS-1500 (OLD) form received with
or without an NPI. Only the revised CMS-1500 (8/05) form
will be accepted. An NPI is not yet required on the CMS-1500
(8/05) form, but should be entered if a provider has obtained
an NPI. It is still highly recommended that claim submitters
enter the Medicare Legacy number that corresponds to each
NPI reported on the revised CMS-1500 (8/05) to avoid a possible
processing delay.
May
23, 2007 and thereafter
Revised CMS-1500(8/05) forms received without an NPI to
identify each provider for which data is reported on a claim,
such as a rendering, referring or ordering physician, in
addition to the billing provider, will be rejected by Medicare.
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GREAT
WEST LIFE
This
group is no longer accessing PCC for chiropractic |
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FYI
Should
an insurance company ask for further documentation i.e.:
insurance card, SOAP notes, or EOBs, please
send that information straight to the
company asking for this information. PCC does not need to
receive this first
unless we are the ones requesting it. |
HOLIDAY
OFFICE SCHEDULE
Office
Closed
November
23
November 24
December 25
January 1
The PCC staff would
like to wish everyone
a safe and happy
holiday season . |
I don’t know the key to success,
but the key to failure is trying to
please everybody.
Bill
Cosby,
Actor, Comedian
(b. 1937) |
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