Information for Providers outside the State of California

The insurance industry is rapidly moving towards managed care because it is more cost effective than traditional fee for service plans. All forms of insurance (health, auto and work comp) are being included in the new integrated managed care plans. AcuNET® was created to give Licensed Acupuncturists a place in this new health care delivery system.

What does AcuNET® do for the insurance company?

AcuNET® provides two services that make insurers and other third party payers happy to provide acupuncture benefits to those they insure: Credentialing and Case Management.

What is Credentialing?

Credentialing is the way AcuNET® assures that the providers in the network are the best available. Each provider in the network must meet minimum standards to be included. AcuNET® guarantees that each provider meets those standards by verifying directly with the source as to the accuracy of each standard met by the provider. For instance, AcuNET® must have a letter on file from the malpractice insurance carrier verifying the coverage of every provider in the network. Similar verification is on file for educational background, malpractice claims history, current status of license, etc. AcuNET® meets national (NCQA) standards of verification. AcuNET® also conducts site visits to every provider's office to verify compliance with AcuNET® policies (commercial location, disposable needles, etc.) and to ensure a professional appearance.

What is Case Management?

As the name implies, someone other than the provider is managing the care given to the patient. Usually, this means that a nurse or clerical person reviews your claims and decides what services to cover and what services to deny. AcuNET® was formed to allow Licensed Acupuncturists to control their own destiny in this regard. Each week a rotating panel of AcuNET® providers meets to review the requests for certification(i.e., approval of how many treatments and at what intervals the patient can be seen for a particular condition). These request are accompanied by a copy of the patient intake and exam forms (which the provider faxed to AcuNET®). The certification decisions are faxed back to the provider promptly to ensure continuity of care. The beauty of having L.Ac.'s do this review is that we know that acupuncture is useful for much more than just pain control. Also, the treating provider gets the benefit of suggestions from other licensed acupuncturists as to additional treatment possibilities. The idea is that AcuNET® functions as a large group practice. Each member benefits from the experience of others in the network. Training seminars are also given periodically to enhance the skills of providers. These have been given free of charge thus far, and provide CEU's to those who attend.

How does it work?

The patient is given an 800 number which connects to the AcuNET® office. The staff takes information from the caller and, using a database with all the information about each provider in the network, helps the caller to locate an acupuncturist who meets their needs. The primary consideration is location, but if the patient needs a provider who speaks a certain language, has unusual hours, particular expertise in a certain type of condition, handicap access, or if the patient has a gender preference, etc., AcuNET® makes every effort to find the provider who best meets those needs. The AcuNET® staff gives the phone number to the patient, then verifies insurance coverage and faxes the patient information to the provider. After examining the patient, the provider faxes treatment and billing information to AcuNET®. After examining the patient, the provider can treat the patient 3 times while awaiting further certification. AcuNET does the billing and reimburses the provider.

What are the fees?

AcuNET® charges a $300 fee to cover the costs of credentialing. This is not an annual fee. AcuNET® also withholds 20% of the amount billed to cover costs of marketing and contracting with the carriers, legal, accounting, insurance and other office expenses. (AcuNET® is owned by providers who are also shareholders. Please let us know if you are interested in buying shares in the corporation). Reimbursement rates are based on the idea that acupuncture and Oriental medicine take time to perform. By contract with the providers, AcuNET® cannot negotiate a contract with a payer that reimburses less than the California Worker's Compensation fee schedule. That means $55 for acupuncture. Other codes may also be billed.

What about states outside of California? AcuNET® is looking for acupuncturists who wish to participate in creating networks outside California. If you are willing to participate in this process, please indicate that on your resume.

What we need is acupuncturists who can help us to identify which practitioners in your state are good, ethical, and willing to work in a managed care environment. Once we have contact information on those individuals, we will recruit and begin the credentialing process. Then we will need someone nearby (you?) to inspect the offices of those acupuncturists, using the form and standards created by AcuNETs. We will reimburse you for your time.

Once we have a network of credentialed providers in your state, we can begin marketing that network to the payor groups in your area. When we have a contract that is delivering patients to providers in your state, we will need licensees in your state (you?) to perform case management. We will be closely involved in the case management process and provide training and supervision to the case managers in your state.

We believe that AcuNET® can help acupuncturists get into managed care throughout the United States quicker and with greater credibility than could provider groups working independently in the individual states. This is because AcuNET® has already spent over $200,000 and 2 years developing the infrastructure for the organization. It would be nearly impossible for other provider groups to do this particularly in that other states do not have the necessary numbers of providers from which to draw. California has approximately half of all the acupuncturists in the United States. We have an economy of scale which makes an organization such as ours possible.

AcuNET® exists to bring acupuncturists into the mainstream of health care in this country. If you wish to participate in this goal, please send your resume and state your intentions as soon as possible. Thank you.

Thank you for taking the time to read this. If you are interested, please send us a resume. We look forward to hearing from you.

AcuNET®
5363 Balboa Blvd., #234
Encino, CA 91316
Tel: (818) 788-5360
Fax: (818) 789-6077


AcuNet@aol.com


Yin/Yang Symbol Acupuncture.com