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HNS healthcare professionals should always verify eligibility and benefits prior to rendering care. Since HNS does not have access to the patient eligibility and benefit information, you must contact the payors directly to verify eligibility and benefit coverage information.

The HNS Verification of Eligibility/Benefits Form should be used to verify eligibility and benefits. This form will assist you in remembering to ask all the appropriate questions. A copy of this form must be maintained in the patient’s healthcare record.  

 

Use Only the HNS EIN and NPI.

When verifying eligibility of benefits, do not give the provider's EIN or NPI. Always provide the HNS EIN (56-1971088) and HNS' NPI (1093773392). This is necessary because payors list contracted providers under HNS' EIN and NPI.

 

Benefits vary from plan to plan and some plans have no chiropractic benefits. When verifying benefits, always determine if the member has a co-payment, co-insurance and/or deductible and if there are any chiropractic limitations to the member's plan.  Always identify yourself as a chiropractor and verify that the services to be provided are covered when performed by a chiropractor. 

Please remember the information you receive when verifying benefits does not take precedence over payors corporate medical policies.

 

 

NOTE:  Members of the Federal Employee Plan (FEP) are not subject to the BCBSNC Corporate Medical Policy. Providers should contact the FEP plan to verify what services are covered chiropractic benefits. 

 

Coverage and benefit related denials occur frequently but can be avoided if you properly verify eligibility and benefits (and update your practice management software with the new information) prior to providing any services.

To prevent denials, always verify each service/DME that you expect to provide.

 

Always document:

  • Date and time of the call
  • The name of the person that provided you with the eligibility/benefit information
  • Dates of coverage
  • All information you received from the payor regarding eligibility and benefits.
  • The call reference number

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, remember to update the patient's insurance verification form in the patient's healthcare record and change the information in your practice management software prior to filing any claims.

 

NOTEIf, when verifying benefits, you are told that a 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 and this waiver must be maintained in the patient's healthcare 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.  Click here for the Non-Covered Services Waiver.