I would like to apologize for not blogging for quite a while. During the past year we have had an increase in the number of insurance companies that have credentialed us or we are working on a case by case assignment. We have been able to add Blue Cross & Blue Shield, Aetna and UBH. As you all know there are many different codes for our service depending on the insurance providers. We have now also learned that there are many different guidelines for service, depending on the insurance provider or carrier. these guidelines appear to establish medical necessity for or clients. Failure to meet medical necessity guidelines will result in the termination of case.
So, if you are going to take on any new cases from new insurance providers we suggest the following:
1. Contact provider relations representative to see if you can get a copy of the guidelines.
2. Do some online research for the documentation.
3. Review the documentation to develop a checks and balances on what activities must occur so that you may stay in compliance with the insurance provider or carrier. this could be done by creating a super-bill that includes all of the activities that BCBA must do on a monthly basis and a template for the quarterly or six month reviews that reflect the actions of the BCBA and your line-staff.
I currently have the guidelines for Cigna, Aetna, UBH and Humana Tricare. I am currently looking for Humana, AvMed, & Blue cross & Blue Shield.
If you have any questions, or info please post them on the blog or email me at newwayday@gmail.com Please subject your emails, Attn. Jose & Cary Blog questions.
- Posted using BlogPress from my iPad
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