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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
New/August 2012
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 enter provider and patient data into the AMI Clinical Outcome Management System (ACOMSSM) on all Chiropractic episodes of care of which the program applies. Please gather the data via Patient Questionnaire(s) and Provider Treatment Notification Forms and enter both forms at the initial patient visit and at monthly follow up evaluations 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 ACOMSSM system, yet provides the Chiropractic service and submits the services on a claim to Blue Cross of Idaho, such provider may be considered non-compliant. On occasion, situations may arise in which ACOMSSM entry may not have been entered. Failure to enter services into ACOMSSM should not be the norm, rather the exception.

Providers who demonstrate a pattern or non-compliance with data entry to ACOMSM will be reviewed on a monthly basis by AMI and will receive a non-compliance letter. Those showing qualified paid claims that do not have a corresponding episode of care match will receive a letter notifying them that compliance with the Chiropractic Care Quality Initiative is required within 30 days. To assist provider offices in becoming compliant, this letter will include those patient names for which claims have been submitted and paid, but have no matching episode information in ACOMSSM. AMI Provider Relations staff is available from 7AM MST to 5 PM MST Monday through Friday at 855-432-2267 to answer any questions about patient data entry, compliance and provide training as necessary.

The following are examples of situations in which an ACOMSSM 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 ACOMSSM 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 ACOMSSM entry may not be present, but represents examples when failure to enter the required patient data may be excused.

To notify AMI of an ACOMSSM entry that either should have been entered or cannot be located, please contact Marcia Marek at 855-432-2267. If you have specific questions about which services require entry into ACOMSSM or how the process works, please contact your provider relations representative.


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