03 Dic Anthem Blue Cross Single Case Agreement
If the patient has not had the chance to find a sufficiently qualified network provider, then the patient pleads for an SCA with the out-of-network provider before the start of treatment. A plan to consolidate, integrate or coordinate the group health plan, the disability plan and the workers` compensation program (according to state regulations) into a single health benefit plan covering workers 24 hours a day. A television series with panels of doctors, patients and related experts dealing with complex medical cases in real life. 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 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. 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.
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.