Member Benefits & Practice Solutions
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TABLE OF CONTENTS
Special Treasures Member BenefitsGroup Medical Insurance, Life, Dental and Vision
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Special Treasures Member Benefits
Attention ACS Members: You can now log in to the ACS webpage and then all of the documents below will become "live" and will open when you double-click on them. Just go to to the Login Button on the top left of every page. Enter your email address and click "Forgot Password." Your password will be emailed to you. Use it to log in and then return to this page and you will have instant access to all of the documents. New members gain access immediately upon joining.
Group Medical Insurance, Life, Dental and Vision Programs for Members
ACS offers its members a wide range of benefits and services including a group medical, life, dental and vision programs.
1 -- Group Medical, Life, Dental and Vision Programs -- Membership Form.pdf: Group health insurance for ACS members with guaranteed issue coverage begins after a one year waiting period with no medical underwriting. PPO HSA and HMO plans are available statewide.
2 -- Group Medical Insurance Info.pdf
3 -- General Benefits and Group Medical Insurance Pamphlet.pdf
Insurance Claims and Denials Solutions
4 -- Fees allegedly above Usual and Customary.pdf: How to protest when an insurance company claims your fees were too high.
4.1 – Chiropractic Lifecare of America Page.pdf: The solution for your cash practice.
5 -- Grievance Letters -- The Best Way to Get Insurers to Pay.pdf: How to use the Arizona grievance law, a powerful tool to bring pressure on an insurer that misbehaves.
5.1 – Grievance Letters and Law Explained.pdf
6 -- Health Care Appeal Request Form.pdf: There is a legal process when a claim is denied as not medically necessary. This is a sample request form. #7 contains complete instructions.
6.1 – Health Care Appeal Request Form for Expedited Medical Reviews.pdf
7 -- Health Care Appeals Process.pdf: A three level process. The third level involves review by an independent party chosen by the Arizona Department of Insurance and paid for by the insurance company.
8 -- How to file a complaint with ADOI against an insurer.pdf: When insurance companies violate laws, complaints must be filed.
9 -- Medical necessity appeal letter.pdf: An excellent general appeal letter.
10 -- Small Claims and Justice Court Instructions.pdf: Sometimes the only solution when an insurance company does not pay is a lawsuit. Here are instructions for suing an insurance company.
10.1 – Small Claims and Civil Suits Instructions Simplified.pdf
11 -- Timely Payment of Claims, Adjudication, Adjustments.pdf: Claims must be paid within a certain time frame, and demands for repayment can only be made within certain guidelines. This document contains the legal details.
11.1 – Timely Payment of Claims, Adjudication and Adjustments.pdf: ADOI Info Brochure.
11.2 – Post Payment Audit Demands Information.pdf
11.3 - Letter to Fight a Refund Demand.pdf
11.4 - Must Insurance Company Payments Made In Error Be Returned by William Sturm
Erisa and Self-Insured Health Plan Tools to get Claims Paid
12 -- ERISA Claims Procedure DOL Rule 29 CFR 2560.503-1.pdf: Key section of the law which you need to know to get results with your appeals.
13 -- ERISA Letter to File an Appeal.pdf: Use this letter today to get results when claims are denied.
14 -- ERISA Letter to Request for a Copy of the Summary Plan Description, Claim Appeal Procedure, EOB.pdf: The first step in an ERISA appeal is to get a copy of the plan document. This is the letter to send.
14.1 -- ERISA Patient Authorization Form.pdf: Your patients must sign this form so that you can file appeals and request a copy of the Summary Plan Description on their behalf.
15 -- ERISA Self-Insured Plans ADOI Letter.pdf: This is the position of the Arizona Department of Insurance regarding ERISA self-insured plans.
16 -- Understanding ERISA.pdf: Complicated subject, simple explanation.
17 -- Understanding ERISA Detailed.pdf: Complicated subject, detailed but understandable explanation.
MD-DC Practice and Referrals
18 -- The path to medical referrals.pdf: Key information about how to get referrals from MDs and DOs.
19 -- MD-DC Alignment in Practice.pdf: An entire book by a DC who once was a drug representative and knows exactly how to get into and talk comfortably with MDs and DOs. This is a blueprint with detailed plans.
Record Keeping and Documentation Compliance Guidance
20 -- Record Keeping as Mandated by the Arizona Chiropractic Board.pdf: Detailed instruction complied and updated by ACS over many years.
21 -- Record Keeping and Documentation Course.pdf: Outline of course given by lead auditor retained by the Arizona Chiropractic Board.
22 -- Record Keeping 2005: Full course notes given by former Chiropractic Board chairman. Click here to open this 56 page document with complete instructions on record keeping.
23 -- Medicare Noridian Chiropractic Coverage and Documentation 2010.pdf
24 -- CMS Rules for reporting timed codes.pdf: These are the rules for reporting timed codes which you must follow to be in compliance with the requirements of the Arizona Chiropractic Board for all documentation.
24.1 -- Forms:
- Informed Consent
- Nordhoff Patient Intake Form 2000A
- Nordhoff Patient Intake Form 2000A Updates
- Nordhoff Patient Intake Form 2000B
- Update to Nordhoff Forms
- Pain Drawing 2011
- Medicare Records 2011
- Pain Intensity and Disability Graph for Documenting Recovery
- Progress SOAP Note
- Outcome Assessment Tools for Neuromusculoskeletal Conditions including Numeric Rating Scale, Visual Analogue Scale, Oswestry, Roland Morris, Neck and Extremity Disability, Fear Avoidance, Patient Health Questionnaire and more.
Lawrence S. Nordhoff, Jr., D.C., is the preeminent author of chiropractic office forms today. Forms #3-9 above were created by him. ACS urges you to buy his entire book of forms for only $150. His webpage is http://www.chiropracticofficeforms.com/chiropracticofficeforms.html. Part of the purchase price will be donated to the ACS legal fund.
24.2: Functional Capacity Questionnaire and Examination Forms
BCBSAZ requires that you show functional improvement in your patients with changes that can be objectively measured or they will not pay for chiropractic care. Simply treating pain and subluxations is not sufficient justification for coverage under current BCBS contracts. Click here for the BCBS response to a Small Claims Court lawsuit filed by a doctor over a denied claim which explains the BCBS requirements clearly. The following are the tools you need to objectively document functional deficits. Questionnaires and evaluations should be redone at least once every 30 days.
1. Functional capacity questionnaire
2. A Critical Review of Functional Capacity Evaluations: full text journal study
3. Functional capacity as a Evaluation as a Performance Measure: full text journal study
4. Short-Term Functional Capacity Evaluation with Low Back Disorders: full text journal study
5. The Interrater Reliability of a Functional Capacity Evaluation: full text journal study
6. Outcome Assessment Tools for Neuromusculoskeletal Conditions from BCBS: 12 different questionnaires, indexes, scales, etc.
Miscellaneous
25 -- Medical Records Protocol 2010.pdf: Arizona Chiropractic Board requires you have this on file in your office at all times. ACS updates the Protocol whenever the law changes and sends the updated version every year to members.
26 -- How to search the National Library of Medicine and retrieve articles from a medical library.pdf: These are the types of journal articles the Arizona Chiropractic Board requires you to have to back up your claims.
27 -- DC Power of Attorney directing payments to doctor.pdf: Use when an insurance company refuses to honor assignments of benefits.
28 -- DC Power of Attorney Instructions.pdf: Instructions for #27.
29 -- State Board Investigations and Disciplinary Actions.pdf: Every doctor with a state license needs to read this background document about boards and discipline. Forewarned is forearmed.
Personal Injury Tools
30 – Ethics Opinion 98-06 which requires PI lawyers to pay your bill if they know it exists (constructive knowledge) even if there is no written agreement.
31 – Balance Billing in PI Cases: Why balance billing to a third party insurer is almost always allowed in PI cases including citations to legal authorities.
32 – PI Attorney’s Explanation of Healthcare Provider Liens: Detailed explanation of the law.
33 – Sample form for Notice and Claim of Medical Lien: Fill in the blanks with your office information.
34 – Sample form for Release of Medical Lien: Fill in the blanks with your office information.
35 – Arizona Department of Insurance Circular Letter 2000-02 mandating fair investigations of low speed impact automobile accidents. Use to combat insurance company fraud.
36 -- Forms:
Lien Forms for Health Insurers that Refuse to Honor Assignments and for Auto Insurers UM/UIM and all Claims
37 -- Assignment of Health Care Insurance Receivables for Adult Patient
38 -- Assignment of Health Care Insurance Receivables for Minor Patient
39 -- Comprehensive Explanatory Article: "Lien Statute Helps Providers to Collect."
How to Qualify as a Courtroom Expert in Clinical Biomechanics
ACS has developed a Position Paper documenting how your chiropractic education has provided you the foundation to be a courtroom expert in clinical biomechanics today. Click here to read the Position Paper. Click here and here to read the key supporting documents. Now, get ready to testify!