In such a situation, a negotiation takes place between the network provider and the practitioner in charge. The overall goal is to ensure that the insurer pays similar fees per meeting in order to keep the client`s fees as close as possible to the original. Once an agreement has been reached, the new terms set out in the SCA will apply. Since a PHA is rarely a repeat offender, it is important that the patient understands their financial responsibility in all intermediate windows between coverage or in the event of non-granting of ACS. A proactive approach reduces the delay in care, which benefits both the therapist and the patient. In the case of a patient who needs to move from your care to a new network provider or a patient who prefers to remain in your care, you may need to help the patient address their request to the insurance provider. Some insurers require that the case-by-case agreement be that of the rendering provider, which must be submitted on claim form 1500. For a current patient who has purchased new insurance, it is also important to note that some insurers have standard protocols for case-by-case negotiation. Some have a “Pay At The Highest Rate”, as if you were a network provider. This is based on their tariffs without the need for negotiation. Many therapists use single case agreements (SCAs) to keep patients who are witnessing a change in insurance. An ACS is an agreement between a therapist and an insurance company with which you are not connected (OON) that allows you to be effectively treated in a network for the case of a particular patient. Patients benefit from continuity of care with the same therapist they are familiar with and therapists benefit from maintaining relationships with patients and often getting the same or similar rates.
An ACS should in principle meet the patient`s unique needs and cost benefits to the patient`s insurance company seeing you, not to a network provider. Here are some of the conditions that must be met in order for an ACS to be granted: for a long-term patient, the new insurance company may react positively to the argument that you guarantee continuity of care. If the patient cannot afford the benefits of OON to see you, and if there may be setbacks, if he had to start over with a new therapist (network), make sure that the insurance company is aware of this. What needs to be considered when approving agreements on a case-by-case basis Approving an agreement on a case-by-case basis can be a tedious and tedious task. Our task is to help you in this task. However, if the FCC has been approved, our task is not complete. Here we need your support to take into account the following aspects: Case-by-case agreements must also use authorized aba CPT medical billing codes. It is important to describe them in the negotiation process with the insurer. This reduces the risk of late claims. When switching to a new network provider, the SCA CPT code may be specific to the number of remaining sessions….