[thekac.org]
For Chiropractic In Kentucky!
What you need to fight for insurance fairness
On this page you will find information that is pertinent to insurance relations in the State of Kentucky. We will be posting information and documentation that you can use to fight undesireable actions by the insurance companies.
Additionally, if you have EOBs that may prove discrimination against chiropractors, including disparity in pay between providers for the same service and EOBs showing codes being changed by the insurance company, send to the address below. Please try to rectify the situation with the insurance company before forwarding information. Thank You.
Send sanitized (remove doctor and patient identification) information to:
Andrew P. Slavik, DC
427 Redding Rd.
Lexington, KY 40517
New KAC Insurance Complaint Form
The KAC is introducing a new reporting process for members to communicate insurance issues to the KAC. Please use the “KAC Insurance Issue Report Form” to record concerns regarding insurance payments, new policies imposed or any other problem you are experiencing with insurers. The form can be found on our website www.thekac.orgor see Page 9. As always, if you have problems with insurers, continue to appeal the issue and send a copy to the KAC and to the Kentucky Office of Insurance (KOI). Feel free to contact any members of the KAC Insurance Relations Committee with any questions you have related to health insurance. We are here to help.
Aetna Policy on Chiropractic
Below is information on Aetna's Policy on chiropractic reference in the voice by Dr. Andrew Slavik. The document for download below explains their policy.
Download the full policy in pdf here.
Help the ACA deal with issues with ACN
The ACA is requesting your assistance with a serious issue that seems to be affecting many doctors. So far, we have received complaints from 27 states reporting difficulties when trying to call for benefit information or to obtain pre-service approvals from United HealthCare (UHC) and ACN Group, Inc. (ACN). You are well aware of how untimely responses of UR decisions impedes patient care and that most all states have insurance regulations with a specific timeframe for response for this very reason. The ACA's goal is to provide information on this problem to the appropriate state regulatory agencies for their immediate attention and action.
You may have seen the ACA’s previous requests for information from providers regarding this issue. Knowing how difficult it is for doctors to take time from their busy schedules to submit information, we have created a quick survey doctors can complete online that will provide exactly what the Attorneys General and Departments of Insurance need to be aware of.
The survey is located at: http://www.zoomerang.com/recipient/survey-intro.zgi?p=WEB2263UH2ZF49 (no provider names will be shared unless you indicate so on the survey by providing your name and demographic information.) The ACA has strongly supported the KAC in our fight with managed care companies. Please take the time to complete this survey within the next two weeks.
Formal Office of Insurance Complaint Form
Below is a link to the official office of insurance complaint form. This form can be used to file a formal complaint with the office of insurance regarding an insurance company, agent, adjuster or other.
If you need to file a complaint follow this link -- https://doi.ppr.ky.gov/Kentucky/secured/KOI/consumer/Complaint1.aspx
Consumer Complaint form
Below is a link to the official office of insurance consumer complaint form. This form can be used to file a formal complaint with the office of insurance regarding an insurance company, agent, adjuster or other.
If you or your patients need to file a complaint follow this link -- http://doi.ppr.ky.gov/kentucky/Documents/pubs/FilingComplaint0108.pdf
Changes in Medicaid
Effective October 1, there are yet more changes happening with Medicaid in the state of Kentucky. For the most recent information about these changes check out the KAC members only section.
Changes in Medicare
The annual L.B. Payne Insurance Seminar was a huge success. Thank you, to all that attended. There were a lot of important topics covered. Remember to continue to document correctly. If you do not take an x-ray, make sure the P.A.R.T. method is very evident in each daily note.
Medicare is in the process of conducting audits on chiropractors due to the OIG’s report. There have been reports of Medicare requesting funds back after the audit process. If you, or anyone you know, has gone through or is currently going through this process, we need to know. We are currently gathering information to ensure Medicare is performing these audits correctly. The only way we can track the audit process is with your input. If you have any Medicare problems or are going through the audit process, please call Nick Payne at (859) 525-7443.
Look for more upcoming Medicare educational sessions throughout the state. Currently, additional sessions in each district are being planned. The KAC is doing every thing we can to ensure that your documentation will hold up to a Medicare audit.
June 2006 - Beginning in July 2006, Medicare changed the requirements for “Initial Treatment Date”. These changes can be viewed here in the members only section.
CCGPP Best Practice News
To view the KAC’s response to the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) Low Back Best Practice document click here.
Changes in Worker Compensation
The Office of Workers’ Claims continues to review the Utilization Review regulations for possible revision. Updates will be posted on the website as they become available. The 2005 Medical Fee Schedule remains in effect.
Documenting patient improvement more effectively is essential in the Workers’ Compensation program. There are various clinical parameters which have been proven valid and reliable as clinical outcome markers. These can be easily documented in the history, clinical exam, with outcomes questionnaires and comparison on re-evaluations. Special emphasis should be placed on the use of grading scales and performing periodic re-evaluations.
An excellent set of clinical forms and outcome questionnaires are available for purchase on a CD using this order form.
ACN Group, INC.
March 2007 - If you continue to have problems with ACN Group or any other managed care group – We need to hear about it! And you need to file a complaint with the KY Office of Insurance (OOI). This link will allow you to quickly and easily file online complaint form. The OOI has become an advocate of the chiropractic profession concerning ACN Group’s management practices and they need the formal complaints from you in the field.
August 2006 - We request that you write the Kentucky Board of Chiropractic Examiners (KY BOE) and ask them to investigate the unfair practices of ACN Group, Inc. Topics in the letter should include that ACN Group, Inc. is restricting the care of your patient and is performing peer review/utilization management without reviewing or obtaining your treatment records. In addition, if you have been terminated from participation with ACN Group, Inc. you should complain to the KY BOE as to the reasons why you have been terminated. Your letters should be mailed to:
Kentucky State Board of Chiropractic Examiners, P.O. Box 183, Glasgow, KY 42142-0183
Please send a copy of the letter to:
Dr. Teri Prince, 108 N. 7th St., Murray, KY 42071 or
Dr. Andrew Slavik, 427 Redding Rd., Lexington, KY 40517
or a copy of the letter via email to taprince@mchsi.com or kychiro@aol.com
Anthem
March 2007 - The KAC has been receiving complaints regarding the recent Anthem fee schedule change effective June 8, 2007. Please take an active role and let Anthem know your displeasure with this new fee schedule. Address your complaints to Kathleen M. Lower, Director, Network Management, Anthem Blue Cross and Blue Shield 13550 Triton Park Blvd. Louisville, KY 40223-4194. Additionally, send a copy to Ms. Julie McPeak, Rep. Tommy Thompson (Chair, KY Banking and Insurance Committee), PO Box 458, Owensboro 42302, your local Senator and Representative, and fax a copy of your letter to the KAC at 270-422-7994.
Humana
July 2007 - After a complaint was filed with the Kentucky Office of Insurance (KOI) by the KAC Insurance Relations Committee, the third party administrator, PMMI of Florida was fined for operating as a third party administrator (TPA) without a license to do so. PMMI has been operating as a TPA, administering chiropractic claims adjudication for Humana since 2002 in Kentucky. On April 26, 2007 the KOI ordered PMMI to pay a fine as well as follow the proper filing procedures to become licensed and cease operations until such licensure is obtained. If you have ever been or are currently a participating provider with Humana through PMMI we need to hear from you. Please contact the KAC via email or phone and give us your name, address and phone number as well as indicate what years you have been contracted with PMMI. Additionally, if you have seen Humana patients as “out of network” in the PMMI regions, we need to hear from you as well.
March 2007 - The Insurance Relations Committee continues to work on the Humana/Healthways issues in Northern Kentucky. Thank you to all the N. Ky doctors that are participating in those activities. Dr. Mike Thompson has been a wonderful contact and leader in that area.
Around the 8th of March you may have received a letter from Humana and OrthoNet stating that all Physical Therapy services must be pre-certified through OrthoNet starting March 1, 2007. Humana representatives say that this process does not apply to chiropractors in any way. We are waiting for solid clarification and have requested that Humana/OrthoNet send clarification to all the chiropractors that were originally sent letters. Be sure to look for that in the mail.
August 2006 - As of Monday, November 1, 2005, all three Humana platforms (three computer systems), were to have been updated to take only one co-pay per date of service for all chiropractic services performed on that date, regardless of the employer. It has come to the KAC’s attention that multiple co-pays continue to be charged to the patient. We need all doctors to fax EOBs with multiple to co-pays to Freda Hogan with Humana at 502-508- 4023 with a short explanation. In addition, fax a sanitized copy (remove doctor and patient identifying information) to Dr. Andrew Slavik at 859-273-8673.
Humana will not automatically go back and adjust previous claims; however, they will adjust upon request. The patient or doctors office will need to call with dates of service and request for adjustment. As always, document your calls and make note of whom you talk with.
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