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Presents
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Jan. 18. 2003 |
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North Carolina Chiropractic Association
Attention DCs and CAs:
Need Training on HIPAA
Compliance?
Health Claim Denials
and Appeals?
If you said yes, sign up today
for the next installment of our
"Building
Your Practice" Series!
* Saturday, January 18, 2003
Holiday Inn Raleigh-Durham Airport
* 9:00 am - 6:00 pm
Research Triangle Park NC
Sponsored by the North
Carolina Chiropractic Association
Please note: The HIPAA portion ot this
program is approved for three hours of license renewal credit In North
Carolina. |
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HIPAA Privacy Program with
Dr. Kate Rufolo, DC
Our opening presentation is a
detailed review of the new regulations required under the Health
Insurance Portability and Accountability Act issued by Health and Human
Services. Topics to be covered are vital to your practice and include
the following:
Who Is Covered By HIPAA
Permitted Uses & Disclosures of
Health Information
Forms & Authorizations
HIPAA Privacy Policies and
Procedures
Resolving Conflicts Between
Consents and Authorizations
Internal Security for Patient
Information and
The Patient's Right to Access
Their Health Records
Your registration will also
Include a copy of the NCCA HIPAA Compliance Manual Don't be left out!!
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Health Claim Denials and Appeals Seminar
with
Dr. Jin Zhou & Dr. Spyros Bakis
Following the HIPAA program will be a five-hour intensive and
comprehensive explanation of Federal ERISA claims regulations, which
have been a confusion for over twenty-seven years, This advanced
program, designed for both the practitioner and experienced
insurance filers, will be of enormous benefit to every chiropractic
office. Reasons you should attend:
*This is the FIRST and
ONLY COMPLETE ERISA PROGRAM in the COUNTRY
*ERISA REGULATES 80% of your Health Insurance CLAIMS DENIALS*
*ERISA compliance is mandatory by FEDERAL LAW, 65 FR 7146*
*Your rights to appeal CLAIM DENIALS & DELAYS can be TAKEN AWAY from
you!*
*ERISA offers the BEST PROTECTION for physicians and health-care
providers in Managed Care denials*
THIS PROGRAM WILL ALSO
INCLUDE A REVIEW OF THE NEW
NORTH CAROLINA
"EXTERNAL REVIEW LAW" IN
EFFECT JULY 1, 2002. SPACE IS LIMITED.
REGISTER TODAY!!
For
more information on why an understanding of ERISA regulations will be
invaluable to you and your practice, please visit www.ERISAclaim.com. |
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9:00 a.m.- 12:O0 p.m. |
"HIPAA Privacy Program"
with
Dr. Kate Rufolo, DC |
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12:00 p.m.-1:00 p.m.
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Lunch on your own |
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1:00 pm - 6:00 pm: |
"HeaItbcire Claim
Denials and Appeals Seminar"
with Dr. Jin Zhou and Dr.
Spyros Bakis |
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"Building Your
Practice - Jan. 18th" Registration
Form "Building Your Practice - Jan. 18th" |
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Attendee(s) (Please indicate DC or CA)
_________________________________________________ |
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_________________________________________________________________________________ |
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Chiropractic Office |
____________________________________________________________________ |
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Address |
____________________________________________________________________ |
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City, Stat; Zip |
____________________________________________________________________ |
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Phone |
____________________________________ |
Fax__________________________ |
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Amount Enclosed
$_____ _______Check ______Visa ______Master card _____Discover
Card Number
________________________________Exp. Date__________________ |
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Signature |
______________________________________________________ |
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Mail form with payment to: N.C.
Chiropractic Association, 333.Fayttteville Street Mall, Suite 1500, Ra1eigh, NC 27601
or fax it to (919) 832-0613. Questions?
Call the NCCA at (919) 832-0611 |
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North
Carolina |
Yes |
Applies to any health insurer.
Type of Grievance: Any decision, policy or action of the insurer that
affects the covered person.
Filing Time Limit: None.
Filing Fee: $0.
State Authority: The North Carolina Department of Insurance. |
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1. |
Chapter 12 Rules
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Abstract:
History Note: Authority G.S.
58-2-40(1) 58-50-60; Eff. February 1, 1991; Repealed Eff.
January 1, 1998 pursuant to S.L.
1997-5 s. 4.4. 11 NCAC 12 .0904 REQUIREMENTS FOR UTILIZATION REVIEW
History Note: Authority G.S. 58-2-40(1) 58-50-60; Eff. March 1, 1991;
Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4. 11 NCAC 12
.0905 UTILIZATION REVIEW PLAN 11 NCAC 12 .0906 MINIMUM STANDARDS FOR
UTILIZATION REVIEW ENTITIES 11 NCAC 12 .0907 ACCESSIBILITY 11 NCAC 12
.0908 STANDARD DATA ELEMENTS 1 |
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2. |
Chapter 12 Rules |
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Abstract: History
Note: Authority G.S. 58-2-40(1) 58-50-60; Eff. February 1, 1991;
Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4. 11 NCAC 12
.0904 REQUIREMENTS FOR UTILIZATION REVIEW History Note: Authority G.S.
58-2-40(1) 58-50-60; Eff. March 1, 1991; Repealed Eff. January 1, 1998
pursuant to S.L. 1997-5 s. 4.4. 11 NCAC 12 .0905 UTILIZATION REVIEW PLAN
11 NCAC 12 .0906 MINIMUM STANDARDS FOR UTILIZATION REVIEW ENTITIES 11
NCAC 12 .0907 ACCESSIBILITY 11 NCAC 12 .0908 STANDARD DATA ELEMENTS 1
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3. |
SubChapter E Rules |
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Abstract:
SUBCHAPTER 10E - WORKERS' COMPENSATION RULES FOR UTILIZATION REVIEW
SECTION .0100 - RULES 04 NCAC 10E .0101 UTILIZATION REVIEW PLAN (a) All
insurance companies and self-insured administrators providing benefits
under the North Carolina Workers' Compensation Act shall, within 90 days
of the effective date of these Rules, adopt, file with the Chairman of
the North Carolina Industrial Commission at 430 N. Salisbury Street,
Raleigh, NC 27611 and implement a Utilization Review Plan for containing
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4. |
SubChapter E Rules
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Abstract:
SUBCHAPTER 10E - WORKERS'
COMPENSATION RULES FOR UTILIZATION REVIEW SECTION .0100 - RULES 04 NCAC
10E .0101 UTILIZATION REVIEW PLAN (a) All insurance companies and
self-insured administrators providing benefits under the North Carolina
Workers' Compensation Act shall, within 90 days of the effective date of
these Rules, adopt, file with the Chairman of the North Carolina
Industrial Commission at 430 N. Salisbury Street, Raleigh, NC 27611 and
implement a Utilization Review Plan for containing med
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5. |
Chapter 20 Rules
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Abstract:
CHAPTER 20 - MANAGED CARE
HEALTH BENEFIT PLANS SECTION .0100 - MANAGED CARE DEFINITIONS 11 NCAC 20
.0101 SCOPE AND DEFINITIONS (a) Scope. (1) Sections .0200, .0300, and
.0400 of this Chapter apply to HMOs, licensed insurers offering PPO
benefit plans, and any other entity that falls under the definition of
"network plan carrier" (2) Sections .0500 and .0600 of this Chapter
apply only to HMOs. (3) Nothing in this Chapter applies to service
corporations offering benefit plans under G.S. 58-65-25 o
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6. |
Title 10 - Health and Human Services Rules
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Abstract:
LEGISLATIVE SESSION 2002
OAH Draft of Approved Rule 6/22/02 10 NCAC 03R .6320 MAGNETIC RESONANCE
IMAGING SCANNERS NEED DETERMINATION BASED ON FIXED MRI SCANNER
UTILIZATION (REVIEW CATEGORY H) It is determined that there is a need
for eight additional fixed Magnetic Resonance Imaging (MRI) Scanners
based on fixed MRI Scanner utilization in the following Magnetic
Resonance Imaging Scanners Service Areas. It is determined that there is
no need for an additional fixed MRI Scanner in any other servic
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http://ncrules.state.nc.us/2002rulespendin_/title10healthan_/title10healthan/16108x.htm
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7. |
Chapter 20 Rules
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Abstract:
CHAPTER 20 - MANAGED CARE
HEALTH BENEFIT PLANS SECTION .0100 - MANAGED CARE DEFINITIONS 11 NCAC 20
.0101 SCOPE AND DEFINITIONS (a) Scope. (1) Sections .0200, .0300, and
.0400 of this Chapter apply to HMOs, licensed insurers offering PPO
benefit plans, and any other entity that falls under the definition of
"network plan carrier" (2) Sections .0500 and .0600 of this Chapter
apply only to HMOs. (3) Nothing in this Chapter applies to service
corporations offering benefit plans under G.S. 58-65-25 o
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SubChapter R Rules
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Abstract:
10 NCAC 03R .6316 SOLID
ORGAN TRANSPLANTATION SERVICES NEED DETERMINATION (REVIEW CATEGORY H) It
is determined that there is no need for new solid organ transplantation
services anywhere in the State. History Note: Authority G.S.
131E-176(25) 131E-177(1) 131E-183(b) Temporary Adoption Eff. January 1,
2001. 10 NCAC 03R .6317 GAMMA KNIFE UNIT NEED DETERMINATION (REVIEW
CATEGORY H) It is determined that there is no need for additional gamma
knife units anywhere in the State. History Note: Authority
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9. |
SubChapter D Rules
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Abstract:
for the patient's primary
compensable condition, if a physician of that specialty meets the MCO's
reasonable credentialing criteria for that specialty and is willing to
contract to provide their services on a non-discriminatory basis.
History Note: Authority G.S. 97-2(19) 97-2(20) 97-25; 97-25.2; Eff.
January 1, 1996. 04 NCAC 10D .0109 QUALITY ASSURANCE AND UTILIZATION
REVIEW An MCO subject to these Rules shall comply with the requirements
of the N.C. Department of Insurance for quality assuranc
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10. |
SubChapter D Rules
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Abstract:
for the patient's primary
compensable condition, if a physician of that specialty meets the MCO's
reasonable credentialing criteria for that specialty and is willing to
contract to provide their services on a non-discrimiatory basis. History
Note: Authority G.S. 97-2(19) 97-2(20) 97-25; 97-25.2; Eff. January 1,
1996. 04 NCAC 10D .0109 QUALITY ASSURANCE AND UTILIZATION REVIEW An MCO
subject to these Rules shall comply with the requirements of the N.C.
Department of Insurance for quality assuranc |
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Associations for Physicians, Hospitals, Health-care Providers
We are willing to work
with any associations with your co-sponsorship and significant discount
for tuitions and reference books. You may
e-mail or
telephone for more details.
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$10,600 ERISA Claim
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| Recent Federal Court Ruling in a Case with
$10,600 medical claim, insurance Co. refused to pay, provider
made numerous demand for payment in almost one year, but no
appeals filed, the court dismissed the lawsuit because provider
failed to exhaust administrative remedy, as required under ERISA,
by filing ERISAclaim appeals. This situation is so popular
in health-care community.
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$37,350 ERISA Claim
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| Health-care provider alleged medical claims
submitted to Aetna for reimbursement, Aetna asserted no receipt
of medical claims, no written denials. Health-care
provider failed to present proof of claim submission, claim
denial and ERISA claim appeals. This case was dismissed. ERISA
health-care claims are handled in federal court, state law is
generally not applicable.
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Codified in Title 29 of the
Code of Federal Regulations:
Regulations
Selected
links:
2520.102-3 Contents of summary plan description.
2560.503-1
Claims procedure. |
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