For reference, this is a link to download a letter sent to membership in October 2016 by ANJC President Dr. Steve Clarke.
As you are aware, the ANJC and an individual chiropractor previously filed suit against the Horizon OMNIA Plan alleging violation of a number of state statutes as well as the Section 2706 of the federal Patient Protection and Affordable Care Act (“PPACA” or “Obamacare”). The basis of the lawsuit was discrimination against chiropractors for placing a disparately high number of chiropractors in Tier 2 of the OMNIA Plan which has high patient cost sharing obligations compared to Tier 1 with lower patient cost sharing when compared to other similar providers such as physical and occupational therapists.
CMS has released an updated Advanced Beneficiary Notice of Non-coverage (ABN) form (Form CMS-R-131). There are no substantive changes to the form or its usage. However, the updated form has added language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed. The new form also includes the updated expiration date of the form which is 03/2020.
Nominations are now open for ANJC President, Vice President, State Board Seats and Alternates, and Regional Board seats (NE, NW, Central and South). Please see click the link above for more information.
As previously advised, as of April 17th 2017 the New Jersey Department of Banking and Insurance (DOBI) mandates a uniform appeal process using specific forms for pre- and post-service appeals created and provided by the NJ DOBI. Shortly after implementation, it came to our attention that nearly all carriers made changes to their Decision Point Review (DPR) plans following this change. Certain changes found are clearly detrimental to medical providers treating PIP patients and most importantly, to the patients themselves.
June 29, 2017
Speaker: Dr. David Graber
Crowne Plaza Fairfield, 690 US-46, Fairfield, NJ 07004