Publications

What does ‘Blue Card’ mean anyway? What is the difference between Horizon BC/BS and those out of state BC/BS plans? Good questions. So let’s first compare ‘The Blues’ to other carriers you are familiar with. Let’s use UHC. They are a nationwide insurance carrier. Therefore, wherever you are in the US, there is a really

If you have noticed recently that UHC and Aetna seem to be applying a ‘Multiple Therapy Reduction’ to their claims payment, you are not alone. Both UHC and Aetna seem to be adopting Medicare’s policy on using a ‘Multiple Therapy Reduction’ formula when a provider (chiropractor or physical therapist) bills more than 1 ‘97’ code

Appeals for Medical Necessity’! Does the thought of it make you cringe! Well then, how does ‘lost revenue’ grab ya? That’s even worse! Yet – providers ARE throwing away thousands of dollars writing off services not authorized or denied for Medical Necessity. Why are providers in this position? Well, let’s evaluate. How often are you

Are you being paid by Oxford for your new patient exams and re-exams? Once denied, are you getting the runaround when trying to get them reprocessed? Don’t write them off—read on! We attended an Oxford/Triad seminar. During this seminar it was explained by an Oxford Medical Director that Oxford should be reimbursing exams (CPT codes

CB&C, Inc, and Horizon BC/BS – Working together in the interest of Chiropractors and Physical Therapists! Many of you know, as a result of our hard work with Empire BC/BS and Horizon BC/BS, Empire BC/BS updated their systems to allow payment of CPT 98943 for Chiropractors effective November of 2004. Chiropractors throughout NJ have been

Are you a provider that limits Managed Care Contract participation? Do you expect your claims to be paid at R&C (reasonable & customary) instead of insultingly low insurance carrier fee schedules? Have you been scrutinizing your EOBs for your out of network patients? You may be surprised at what you find!! Although many providers participate