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PAP 276

Chiropractic Compliance with Alternative Integration Medicine of Idaho (AMI)


Provider Administrative Policy

Section
Ancillary Provider
Policy Date
August 2012
Status/Date
Revised/August 2014
Provider Type(s)
N/A  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Chiropractic Compliance with Alternative Integration Medicine of Idaho (AMI)

Effective September 1, 2011, Blue Cross of Idaho implemented the Chiropractic Quality Initiative through Alternative Medicine Integration of Idaho (AMI). Providers are required to gather provider and patient data via patient pain questionnaire(s) and enter all required information at the initial patient visit and at monthly follow ups for the duration of the episode of care. Blue Cross of Idaho uses AMI compliance reports to identify non-compliant Chiropractors. These providers will receive notices if they are in violation of compliance with patient data submission. When a provider fails to enter the above mentioned provider and patient data into IMDISTM, the AMI Quality Measurement System, yet provides the Chiropractic service and submits he services on a claim to Blue Cross of Idaho, such provider maybe considered non-compliant. On occasion, situations may arise in which an entry may not have been entered. Failure to enter services into the AMI Quality Measurement System IMDIS should be the exception and not the norm.

Non-compliance with data entry into the AMI Quality Measurement System is measured as paid claims data is received by AMI. Notifications of non-compliance by patient and episode of care are communicated to providers via IMDIS. Those providers demonstrating a consistent pattern of non-compliance may additionally receive a hard copy non-compliance letter requesting corrective action within 30 days and outlining possible consequences. To assist provider offices in becoming compliant, AMI Provider Relations and IMDIS Provider Support Team staff is available from 7 AM MST to 5 PM MST, Monday through Friday at 855-GO-IMDIS (855-464-6347) to answer any questions about patient data entry, compliance and provide training as necessary.

The following are examples of situations in which an IMDIS entry may not be present:

  • Patient presented the wrong insurance card and the provider was not aware the patient had Blue Cross of Idaho (this may occur when the member is newly enrolled in the Blue Cross of Idaho plan or the member hasn't visited the practice in question since his or her new enrollment).
  • Patient is unable to complete AMI forms due to certain physical or mental limitations that render the patient incapable of responding to patient questions, even with the assistance of a guardian and/or parent.
  • Language barriers with the exception of Spanish; Spanish-language forms for patients are available in IMDIS in the Forms and Help Section.
  • If a provider is a new Blue Cross of Idaho contracted network provider (within 30 days of contract effective date.)
  • Workers Compensation claims.
  • If a provider presents a remittance advice from another insurance carrier demonstrating an assumption that another payer was primary.

The above list is not intended to be an all-inclusive list of reasons that an IMDIS entry may not be present, but represents examples when failure to enter the required patient data may be excused.

To notify AMI of an IMDIS entry that either should have been entered or cannot be located, please contact AMI provider representatives at 855-GO-IMDIS (855-464-6347). If you have specific questions about which services require entry or how the process works, please contact your provider relations representative. A failure to meet the contractual requirements may place your network participation at risk.


Policy History

Date Action Reason
August 2014 Revised ACOMS to IMDIS updates

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