Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 31 OS

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"Verification Requests and Timely Answers"

My mantra for 2013 and beyond is, "If you meet the highest standard of practice, documentation and legal requirements in the nation, than no matter what the rules in your state, you will prevail."


This foretelling has held true for being expert in MRI, mandating evidence-based research to back up your insurance claims to get paid and the newest set of rules to follow is the New York 120 day LAW which states:


If the carrier sends a verification request, and there is no response, after 120 days, the carrier can deny.  Thus the verification request, unanswered, becomes in effect a breach of contract, a policy violation, rather than just a means to delay payment.


This is especially important on lost wage claims.  


In New York ,this law goes into effect 4/13/2013.


There is a caveat. Many states allow 60 days to respond to certain verification requests. The only nuance to this LAW is that it now becomes not a delay, but a breach of contract and the New York doctor will NEVER get paid if he/she doesn't respond. This is a first nationally, to my knowledge, and shows the resolve of the carriers to change laws to ensure they get their information in a timely fashion. The reason they do this is so that doctors do not "stockpile" bills to prevent IME's, peer reviews and blanket denials. In addition, they do not want the plaintiffs', your patients', lawyers from having an unfair advantage of time to prepare cases.


You MUST check the laws in your state by going to your state's insurance department and simply asking what the legal requirements are for timely filing of claims, verifications and other informational requests.

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