Health - Managed Care
updated 2-7-10

Blue Cross Blue Shield of Texas

Offices are reporting BCBS of Texas is scheduling an in-office visit.... then requesting records on the spot. 
Things they are looking for .... intersegmental traction tables, e-stim, and manual therapy (see below for details)
click here to read the policy on intersegmental traction  (should you land on the accept page... accept and in the search box type "non covered physical therapy services)
click here to read the policy on e-stim  (should you land on the accept page... accept and in the search box type (surface electrical simulation)

• Policy title changed; previously titled Spinal Unloading Treatment for Low Back Pain
• Revised coverage rationale; updated list of indications for which mechanical traction therapy is unproven to include:
– spinal unloading devices
– spinal decompression
– conventional mechanical devices
• Added 97012 to list of applicable CPT® code
Mechanical traction therapy (spinal unloading devices, spinal decompression and conventional mechanical devices) for the treatment of neck and low back disorders with or without radiculopathy is unproven.
click here to read policy on mechanical traction

Services Not Allowed and Not Billable to the Member
Provider will not receive reimbursement for these services. 
• After Hours and Weekend Care. Code: 99056.  Effective: February 1, 2010.
• DME delivery, set up, and/or dispensing service component of another HCPCS code. Code: A9901. Effective: February 1, 2010.

From American Chiropractic Association BCBS Federal .... WE ARE CLASSIFIED AS PHYSICIANS AGAIN........;-)

BCBSs Policy for Surface Electrical Stimulation dated 6-1-09

Surface electrical stimulation is considered experimental, investigational and unproven for any indication in the outpatient setting.
97014 and 97032
 

BCBSs Policy for Non-covered Physical Therapy

You can have your patient sign an agreement that they know the intersegmental traction is a non-covered service and they will be financially responsible.

more BCBS below

ChiroNET..... CIGNA  newsletter January 2009

            Beginning April 20, 2009, CIGNA will update their Modifier Policy concerning several Modifiers including 25 and 59. 
            Both 25 and 59 will now require supporting documentation with the claim.  Your office must forward supporting
            documentation with your claim in order for ChiroNET to submit the information concurrently.   Submitting the claim
            without documentation will result in the claim being denied and a request fordocumentation generated. 
            Do NOT drop your claims to paper until you get a denial, then file a paper claim with documentation.
5-25-09 We are getting reports that Cigna is now denying claims for the -59 and -25 modifier........ if you receive a denial drop your claim to paper and add your documentation.

–        You can continue to submit claims electronically to CIGNA, even if supporting documentation is required. Indicate in box 19/Loop 2300 of the electronic claim that the documentation will be sent through another channel. The indicators on the electronic claim include the delivery method for sending the attachment (i.e., fax, mail), as well as the description code for the type of attachment (i.e., physicians’ report, operative notes). Supporting documentation can be faxed to CIGNA at 1.570.496.2945 or sent via mail to the CIGNA address on the back of the participant’s ID card.

United HealthCare

           as long as you get the patient's written consent before you do the non-covered service

           United says they need to be in their network ...... or you will be paid "out-of-network" benefits

AETNA

Blue Cross Blue Shield

           Patient must agree in writing to continue treatment and be financially responsible ...... and (Provider must charge allowed amount)

           cash arrangements when you're in-network in lieu of filing claims violates the provider's contract