Diabetes and Heart Care Plan Quick Reference Guide

 

tracelogoRB Reference Guide for the Diabetes and Heart Care Plan

 

HealthTeam Advantage has a new special needs plan for patients who have been diagnosed with either diabetes or congestive heart failure (or both).

 

This plan is referred to as CSNP and is an HMO product. This plan is limited to only Medicare beneficiaries that reside in Guilford County and that have one or both chronic diseases of Diabetes and/or Congestive Heart Failure.

 

Members are easy to identify as the member ID card will clearly state "Diabetes and Heart Care Plan CSNP".

 

As a Medicare plan, coverage is limited to spinal manipulation and the plan has a chiropractic copayment of $20.00.  Just as with Medicare, please be sure to include the AT modifier as applicable.

 

This Quick Reference Guide provides information specific to the Diabetes and Heart Care Plan concerning claims, members, and policies.

 

With the Diabetes and Heart Care Plan (CSNP), it is NOT necessary to obtain either a referral from the member's Primary Care Provider (PCP) or prior authorization from the Diabetes and Heart Care Plan.

 

 

General Information

 

Eligibility/Benefits

 

PCP Referral

 

Prior Authorization

 

Diabetes and Heart Care Plan (CSNP) ID Cards

 

Claims Submission

 

Claims Inquiries

 

Provider Relations

 


General Information 

 

Please do not send claims directly to the Diabetes and Heart Care Plan. All Diabetes and Heart Care Plan (CSNP) claims must be sent to HNS.

 

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating Diabetes and Heart Care Plan provider through HNS, and our instructions for filing claims supersede information given to you by Diabetes and Heart Care Plan (CSNP) Representatives!

 

If you have any questions about the Diabetes and Heart Care Plan (CSNP), please contact your HNS Service Representative. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

 

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Eligibility/Benefits

 

Be sure to ALWAYS verify eligibility for each Diabetes and Heart Care Plan (CSNP) member! 

 

To verify eligibility and benefits, refer to the telephone number on the member's identification card.

 

Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Eligibility/Benefit Form.  

  

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PCP Referrals

 

Referrals from the member's Primary Care Provider (PCP) are not required. 

 

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Prior Authorization

 

Prior authorization is not necessary for Diabetes and Heart Care Plan (CSNP) members.

 

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Diabetes and Heart Care Plan (CSNP) ID Cards

 

              

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Claims Submission

 

Please do not send claims directly to the Diabetes and Heart Care Plan.  All Diabetes and Heart Care Plan (CSNP) claims must be sent to HNS. (Please ignore the billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits.) All primary claims must be submitted electronically to HNS.

 

Group Number:

While Diabetes and Heart Care Plan (CSNP) member ID cards will not include a group number, to ensure the correct adjudication of the claim, please enter either "Diabetes" or "CSNP" as the group number in box 11 of all Diabetes and Heart Care Plan (CSNP) claims.  

 

Diabetes and Heart Care Plan or CSNP must be included in Box 11c on the claim form.

 

Even when filing the claim electronically, the claim must be identified as a Diabetes and Heart Care Plan claim in the address section at the top of the CMS 1500 claim form (HNS/Diabetes or HNS/CSNP are acceptable formats).

 

Example:  
HNS/Diabetes
PO Box 2368
Cornelius, NC 28031

Example:
HNS/CSNP
PO Box 2368
Cornelius, NC 28031

 

With the Diabetes and Heart Care Plan (CSNP), it is NOT necessary to obtain either a referral from the member's Primary Care Provider (PCP) or prior authorization from the Diabetes and Heart Care Plan.

 

If you have any questions about the Diabetes and Heart Care Plan (CSNP), please contact your HNS Service Representative. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

 

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Claims Inquiries

 

For assistance from HNS on claims status, (after 60 days from your billing date), please email your HNS Service Representative and include the patient name, date of birth, member ID number and the dates of services in question. We will gladly trace the claim for you and will respond back to you within 3 business days. 

 

Resubmit lost/missing claims through HNS.

 

Refer to your HNS/Diabetes and Heart Care Plan (CSNP) fee schedule to confirm allowable amounts. All HNS fee schedules are located on the secure section of this website. 

 

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Provider Relations 

 

Questions relating to your participation in the Diabetes and Heart Care Plan (CSNP) should be directed to your HNS Service Representative. Your HNS Service Representative's email address is displayed on the provider dashboard on the secure section of the HNS website.

 

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