Provider News
Greetings Dr.   
September 17, 2010 - Issue 9

In this Article

 
Billing Therapies Without a Manipulation
 
Revised UCare Clinical Appeals Process
 
New HealthPartners Workers' Comp Network Implemented
 
Online Education Credits Available
 
Fast Facts
duplicateBilling Therapies Without a Manipulation
 
Providers can avoid unnecessary payment delays by submitting daily progress notes with any claim that includes a date of service on which a therapy is billed without an accompanying chiropractic manipulation.  Daily notes should reference decision making of postponing chiropractic manipulation to date when deemed appropriate. Failure to provide the required notes proactively will result in a request for information. ChiroCare's policy on using physical modalities in the absence of spinal manipulation can be found under Policies and Definitions on the Clinical Resources tab of ChiroCare Connect. 
 
Providers may access ChiroCare Connect by going to www.chirocaremn.org and selecting "To ChiroCare Connect" at the bottom of the page. To establish a ChiroCare Connect account, simply select "Register" from the ChiroCare Connect home page. 
 

chirocaresponsorRevised UCare Clinical Appeals Process


In follow up to changes made to provider denial communications for UCare members (see details in June newsletter), the process for providers to appeal an authorization/UM decision is also changing. Going forward, all provider appeals related to a current treatment plan must be submitted directly to UCare. Only appeals for treatment plans that have expired will be processed and reviewed by ChiroCare. Clinical appeals inappropriately submitted to ChiroCare will be returned to the provider for submission directly to UCare.  
 
Please note that when appealing a clinical decision, the patient's insurance product dictates the required submission method:
 
Medicare (UCare for Seniors):
Appeal must be submitted in writing
 
State Programs and Dual Eligibles (Medical Assistance, MN Care , MN Senior Health Options, MN Disability Health Options/UCare Complete and UCare Connect):
Appeal may be submitted in writing or verbally over the phone  
 
For additional information regarding submission of clinical appeals, please review the information listed on the applicable denial letter or call the service number listed on the back of the member's UCare identification card. 
 
Appeals related to denied claims rather than authorization decisions will continue to be handled by ChiroCare.

gettoknowNew HealthPartners Workers' Comp Network Implemented

HealthPartners transitioned its Workers' Compensation product to the new Workers' Compensation Network through ChiroCare on September 1st. To date, about 300 of ChiroCare's 1,400 contracted chiropractic providers have chosen to participate in the product-specific network. While participation is optional, chiropractic providers who do not participate are not eligible to receive referrals for the 60,000 employees covered through the Health Partners Workers' Compensation program.
 
To help you determine if this business opportunity is a good match for your office, a variety of resource materials, including a comprehensive Frequently Asked Questions document, have been posted to our web site. Click here to review all resources available.
 
If you wish to participate in the Workers' Compensation network and have not already done so, please sign the HealthPartners Workers' Compensation Contract Addendum and fax the signature page to ChiroCare at (651) 389-2009. Upon receipt, we will execute the addendum and provide you with written notice of your HealthPartners Workers' Compensation effective date.
 
All providers who participate in the Workers' Compensation program are identified in the provider search tool available at www.chirocaremn.org. Additionally, participating providers will be listed in HealthPartners' online Workers' Compensation materials which are currently being updated.

holidayOnline Education Credits Available 

 Looking for a convenient way to fulfill your required continuing education hours? ChiroCare's online provider education tools offer 4.5 credits for providers licensed in Minnesota and South Dakota. The online tools include videos of a Dr. Joe Ferezy presentation hosted by ChiroCare in December of 2009. 
Providers who attended the original seminars offered very positive feedback:
Value of Information presented: 9.46
            Quality of Speaker:  9.88          
            Level of Speaker's Knowledge: 9.75
 
*Values were averaged for the two classes and represent a 10 point scale, 10 being best.
 
To obtain the available hours, view the videos posted to the Online CE Course section of our web site and submit your completed exams to ChiroCare. If you successfully past the exam, you will receive a certificate of completion letter with the applicable hours noted

fastfactsFast Facts

 

Aug 2010

Performance Goal

Average speed to answer the phone

21 seconds

Less than 30 seconds

Volume of calls answered within 30 seconds

90%

Minimum of 80%

Call abandonment rate

1.7%

Less than 3%

Volume of all claims received electronically*

*Per MN Statute 62J.536 all providers in MN are to be submitting claims electronically as of 12/15/09

90%

Minimum of 90%

 


 
 
 
 
 
 
 
 
 
 
 
 
 
 
To access some of the links and materials referenced above, your system must be able to open PDF documents. If you are not able to open PDF documents, you may download Adobe Reader for free by going to http://get.adobe.com/reader.
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