Anthem Blue Cross Single Case Agreement
Sometimes an insurance company may have a „payment policy with the highest in network rate,“ in which case you will not be able to negotiate the rate. You still have the option to refuse the SCA if the sentence and conditions are not acceptable to you. Allows members to obtain health care wherever they live or travel, nationally or internationally. BlueCard connects participating healthcare providers and independent Blue Cross Blue Shield businesses across the country through a unique electronic claims processing and refund network. A use and quality management mechanism to help providers make decisions about the most appropriate treatment for a given clinical case. It should be noted that insurance companies have a legal obligation to properly treat patients by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients. This is because the patient does not simply choose to see you, but is forced to deal with insufficient providers in the network. In this case, the patient usually makes the case with the assurance of an ACS with you before starting treatment. If you receive a CSA for an ongoing patient for further treatment, the negotiated price will be based on the patient`s informed agreement and agreement when they begin treatment with you. Rate increases are consistent with your pricing policy in informed consent.
You cannot charge the patient a lower horizontal rate out of your pocket and then charge the insurance company your full normal rate if the CAS has been dated in the past to cover the meetings. An agreement with a provider not to charge the subscriber a difference between the fees charged for covered services (excluding co-insurance) and the amount agreed by contract with a Blue Cross Blue Shield company as a full payment for these services. A coding inconsistency in which a procedure must be divided into pieces and loaded for each piece, instead of using a single code for the entire procedure. The process of identifying and classifying the risk presented by an individual or group. A person or organization that cares for patients from outside the local plan. Services can be provided from a single site or multiple sites. The service provider is the one who has a right to a service provided to the member. BlueCard applies if the service provider is outside the member`s Blue Cross Blue Shield plan and does not agree with the member`s plan. The member`s location at the time of service is irrelevant.
Often, the patient and the indirect care provider are in different physical locations. A television series with panels of doctors, patients and related experts dealing with complex medical cases in real life. If the patient has recently switched insurance providers, the insurance company may accept a limited number of sessions (approximately 10) and a period (for example. B 60 days since the insurance change) to allow the patient to continue treatment with the current network provider while switching to a network provider. If there is evidence that the person could pose a danger to himself or others, or if it affects the patient psychologically or mentally (for example. B failures in the progress of therapy), if this proves necessary to switch to an in-network provider, a case could be advanced for an increase in adequacy with the current provider. Examples: a patient has an uncertain bond and finds it very difficult to trust others.