Insurance verification

Insurance Verification

HNS cannot overstate the importance of properly verifying member eligibility and benefits for each member, prior to providing any chiropractic services. Coverage related denials and benefit related denials increase your accounts receivables and decrease your cash flow! These denials occur frequently but can be avoided if you properly verify eligibility and benefits (and update your practice management software with all new information) prior to providing any services.

Since HNS does not have access to the payor's patient eligibility and benefit information, you must contact the payors directly to verify eligibility and benefit coverage information for each member before providing any services.

Insurance plans renew and change throughout the year so it is very important to obtain a copy of the member's insurance card on every visit. Remember, when an insurance plan renews, benefits may also change!  If any information has changed, do not forget to update the patient's insurance verification form in the patient health care record and always remember to change the information in your practice management software prior to filing any claims.

1.  Verifying Eligibility:

Please make sure to complete the HNS Verification of Insurance Form prior to rendering services. This form will assist you in remembering to ask all the appropriate questions. This form should always be retained in the patient's health care record.

Always contact the payor directly to obtain current dates of coverage on each patient prior to providing services. When contacting the payor, always check for any changes in the member's ID number, including prefixes and suffixes that are part of the complete member ID number.

If there have been any changes, please make sure to update your practice management software prior to filing any claims.

2.  Verifying Benefits:

Please make sure to complete the HNS Verification of Insurance Form prior to rendering services. This form will assist you in remembering to ask all the appropriate questions. This form should always be retained in the patient's health care record.

Always contact the payor directly to obtain current dates of coverage on each patient prior to providing services. When calling to verify benefits, make sure to identify yourself as a chiropractor and verify the services being rendered on the patient are covered when performed by a chiropractor.

To prevent denials, always verify EACH service/DME that you plan to provide.

When verifying eligibility and benefits, be sure to obtain the name of the payor phone representative, the time and date of the call, and if available, a reference number or fax back confirmation of the quoted eligibility and benefits.  If there are any problems with the adjudication of the claim, you can reference the particular person that verified the eligibility and benefits of your patient.

Please remember the information you receive from a payor phone representative does not take precedence over any payor corporate medical policy for chiropractic. (Please note: members of the Federal Employee Plan are NOT subject to the BCBSNC CMP. Providers should contact the FEP plan to verify what services are covered chiropractic benefits.)  Network providers are expected to know and adhere to all HNS and payor policies, so please make sure you have read and understand the corporate medical policies of the HNS contracted payors.  If you are unsure about any payor policies, please contact your HNS Provider Rep for assistance in determining if the service is appropriate and consistent with payor corporate medical policy for chiropractic.

Chiropractic benefits vary from plan to plan and some plans have no chiropractic benefits. When verifying benefits, always determine if the member has a copayment, coinsurance and/or deductible and if there are any chiropractic limitations to the member's plan.

NOTE REGARDING NON-COVERED SERVICES! If when verifying benefits you are told that a particular service is not covered by the member's plan, you must obtain a signed waiver from the member, specific to the service that is non-covered PRIOR to rendering the service. The patient waiver must be maintained in the patient's health care record. IF you obtain a signed waiver from the member prior to rendering services, you may bill the patient your usual and customary charge for that service. If you do not obtain a signed waiver prior to providing service, you cannot bill the member or the insurance plan for that service.

To view a sample copy of a patient waiver for non-covered services, please CLICK HERE.