Just another reminder: Infinedi EDI recently provided a well-stated reminder of new claim requirements noticed by Florida Blue Cross and Blue Shield to providers in November of 2014. The new requirements are for claims with dates of service on or after January 1, 2015. The reminder reiterates that new requirements will impact secondary claims and any claim that contains an accident diagnosis (such as any ICD-9 code in the 800 series).
The FCA was recently
notified by Florida Blue that those doctors currently participating in the
Florida Blue networks have received or will soon receive a notice informing
that, effective April 1, 2015, American Specialty Health Group, Inc.(ASH) will
manage chiropractic network services for Florida Blue. This applies to most, but, not all of the Florida Blue networks. The notice is posted on fcachiro.org for your reference.
Insurers and networks are constantly revising contracts and agreements. Your decision on whether to participate/sign an agreement is strictly an individual one and you should not consult or discuss whether to participate with any other practice, or inform any other practice whether or not you intend to participate or sign any insurer/network agreement. Some members have sought FCA recommendations as to whether or not they should sign various network contracts: Please understand that the FCA is prohibited by federal anti-trust laws from advising you in your individual decision-making process.
(From the ACA "Week in Review" of July 10, 2014) The Patient Protection and Affordable Care Act (PPACA) defines a grandfathered healthcare plan as those, "that were in existence on March 23, 2010 and haven't been changed in ways that substantially cut benefits or increase costs for consumers." A grandfathered plan can be job-based or individual. As a result, a clinic could have some patients with plans that are grandfathered, and other patients with the same insurer whose plans are not grandfathered depending on when they enrolled. Patients can determine if their plan is grandfathered by contacting their benefit administrator or reviewing materials that describe plan benefits.
Insurance News 